# EAST GRANBY FAMILY PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154308229
- **Authorized official:** MR. STEVEN R DIETRICH MD (PARTNER MD)
- **Authorized official phone:** (860) 653-4526

## Contact information

- **Practice address:** 13 CHURCH RD, EAST GRANBY, CT 06026-0518
- **Practice address phone:** (860) 653-4526
- **Practice address fax:** (860) 653-5209
- **Mailing address:** 13 CHURCH RD, PO BOX 518, EAST GRANBY, CT 06026-0518
- **Mailing address phone:** (860) 653-4526
- **Mailing address fax:** (860) 653-5209

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 12/29/2005
- **Last updated:** 06/26/2013