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NPI Code Detail

MEDICARE: ANIS & MARTIN INTERNAL MEDICINE ASSOCIATES, LLC

MEDICARE: ANIS & MARTIN INTERNAL MEDICINE ASSOCIATES, LLC
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
1207R00000XInternal Medicine Physician018083CT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00269488OTHERCTMEDICARE RAIL ROAD NUMBER DR. ANIS
2DB1187OTHERCTMEDICARE RAIL ROAD
3P00087818OTHERCTMEDICARE RAIL ROAD NUMBER DR. MARTIN

General Provider Information

NPI Number : 1285675082
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANIS & MARTIN INTERNAL MEDICINE ASSOCIATES, LLC
Provider Business Mailing Address
First Line : PO BOX 3136
Second Line :
City : VERNON
State : CT
Zip : 06066-2036
Country : US
Telephone Number : 860-896-1422
Fax Number : 860-896-1425
Provider Business Practice Location Address
First Line : 1504 SULLIVAN AVE
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2711
Country : US
Telephone Number : 860-644-1523
Fax Number : 860-648-9468
Authorized Official
Title or Position : MD
Name : MICHAEL MARTIN
Credential : MD
Telephone Number : 860-644-1523
Provider Enumeration Date : 06/10/2006
Last Update Date : 08/05/2013

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Directions to “ANIS & MARTIN INTERNAL MEDICINE ASSOCIATES, LLC ” Practice Location

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