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General NPI Number Information
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NPI Number | 1437810462
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Entity Type | Organization
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Legal Business Name | CT MEDICAL CLINICS
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 17 FARMINGTON AVE
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City | PLAINVILLE
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State | CT
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Zip | 06062-1700
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Country | US
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Telephone | 860-351-5528
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Fax |
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Provider Business Mailing Address
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Address Line | 17 FARMINGTON AVE
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City | PLAINVILLE
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State | CT
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Zip | 06062-1700
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Country | US
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Telephone | 860-351-5528
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | STEVEN GEOFFRION
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Credential |
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Telephone | 860-351-5528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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