# M.M.DEREN,MD,PC

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

## Provider details

- **NPI number:** 1689931867
- **Authorized official:** DR. MICHAEL M DEREN (PRESIDENT)
- **Authorized official phone:** (860) 443-5469

## Contact information

- **Practice address:** 125 SHAW ST, NEW LONDON, CT 06320-4900
- **Practice address phone:** (860) 443-5469
- **Mailing address:** 125 SHAW ST, NEW LONDON, CT 06320-4900
- **Mailing address phone:** (860) 443-5469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 15198 | CT | Yes |

## Other

- **Enumeration date:** 04/12/2012
- **Last updated:** 04/24/2012