# MIDSTATE MEDICAL GROUP, PC

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

## Provider details

- **NPI number:** 1356361315
- **Authorized official:** DR. FRED F TILDEN M.D. (OWNER)
- **Authorized official phone:** (203) 694-8750

## Contact information

- **Practice address:** 435 LEWIS AVENUE, MIDSTATE MEDICAL GROUP, PC, MERIDEN, CT 06451
- **Practice address phone:** (203) 694-8750
- **Mailing address:** 435 LEWIS AVENUE, MIDSTATE MEDICAL GROUP, PC, MERIDEN, CT 06451
- **Mailing address phone:** (203) 694-8750

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | N/A | CT | Yes |

## Other

- **Enumeration date:** 07/20/2006
- **Last updated:** 04/09/2008