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NPI Code Detail

MEDICARE: ORTHOPEDIC ASSOCIATES OF MIDDLETOWN, PC

MEDICARE: ORTHOPEDIC ASSOCIATES OF MIDDLETOWN, PC
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
1332B00000XDurable Medical Equipment & Medical Supplies
2208100000XPhysical Medicine & Rehabilitation Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225302136
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORTHOPEDIC ASSOCIATES OF MIDDLETOWN, PC
Provider Business Mailing Address
First Line : 512 SAYBROOK RD
Second Line : SUITE 100
City : MIDDLETOWN
State : CT
Zip : 06457-4788
Country : US
Telephone Number : 860-347-7636
Fax Number : 860-894-1894
Provider Business Practice Location Address
First Line : 41 BREWSTER RD
Second Line : LEVEL D
City : BRISTOL
State : CT
Zip : 06010-5161
Country : US
Telephone Number : 860-585-3040
Fax Number : 860-585-3307
Authorized Official
Title or Position : PHYSICIAN
Name : DR. TERRY F REARDON
Credential : MD
Telephone Number : 860-347-7636
Provider Enumeration Date : 02/24/2012
Last Update Date : 02/24/2012

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