# MIDDLESEX HOSPITAL DBA FAMILY PRACTICE GROUP EAST HAMPTON

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MIDDLESEX HOSPITAL
- **Other names:** Family Practice Group East Hampton
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1114062114
- **Legal business name:** MIDDLESEX HOSPITAL
- **Authorized official:** MARISA PELLERIN (CREDENTIALING/ENROLLMENT)
- **Authorized official phone:** (860) 358-4821

## Contact information

- **Practice address:** 42 E HIGH ST, EAST HAMPTON, CT 06424-1099
- **Practice address phone:** (860) 344-6394
- **Practice address fax:** (860) 344-6748
- **Mailing address:** 90 S MAIN ST, MIDDLETOWN, CT 06457-3649
- **Mailing address phone:** (860) 358-6394
- **Mailing address fax:** (860) 358-6094

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | CT | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | CT | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | CT | — |
| 208000000X | Pediatrics Physician | — | CT | — |
| 363AM0700X | Medical Physician Assistant | — | CT | — |

## Other

- **Enumeration date:** 02/20/2007
- **Last updated:** 03/06/2019