MEDICARE: MORPHE'MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1053347641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORPHE'MD

Provider Business Mailing Address
First Line	:	701 COTTAGE GROVE RD
Second Line	:	BUILDING D210
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3080
Country	:	US
Telephone Number	:	860-726-1400
Fax Number	:	860-726-9400

Provider Business Practice Location Address
First Line	:	701 COTTAGE GROVE RD
Second Line	:	BUILDING D210
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3080
Country	:	US
Telephone Number	:	860-726-1400
Fax Number	:	860-726-9400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALFREDO S NINO
Credential	:
Telephone Number	:	860-726-1400

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	08/22/2020

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