MEDICARE: SURGICAL ASSOC OF MERIDEN 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
1	208600000X	Surgery Physician		CT

Other Identifiers

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

General Provider Information

NPI Number	:	1770560245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL ASSOC OF MERIDEN PC

Provider Business Mailing Address
First Line	:	455 LEWIS AVE
Second Line	:	SUITE 216
City	:	MERIDEN
State	:	CT
Zip	:	06451-2121
Country	:	US
Telephone Number	:	203-634-0134
Fax Number	:	203-630-3961

Provider Business Practice Location Address
First Line	:	455 LEWIS AVE
Second Line	:	SUITE 216
City	:	MERIDEN
State	:	CT
Zip	:	06451-2121
Country	:	US
Telephone Number	:	203-634-0134
Fax Number	:	203-630-3961

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LINDA MERCURI
Credential	:
Telephone Number	:	203-634-0134

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	03/13/2014

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