# MIDDLESEX HOSPITAL DBA MIDDLESEX HOSPITAL PHYSICIAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MIDDLESEX HOSPITAL DBA MIDDLESEX HOSPITAL PHYSICIAN SERVICES -PMA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1760940035
- **Legal business name:** MIDDLESEX HOSPITAL DBA MIDDLESEX HOSPITAL PHYSICIAN SERVICES -PMA
- **Authorized official:** MARISA PELLERIN (ENROLLMENT SPECIALIST)
- **Authorized official phone:** (860) 358-4821

## Contact information

- **Practice address:** 540 SAYBROOK RD STE 210, MIDDLETOWN, CT 06457-4759
- **Practice address phone:** (860) 358-6875
- **Practice address fax:** (860) 358-8693
- **Mailing address:** 28 CRESCENT ST, MIDDLETOWN, CT 06457-3654

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/06/2019
- **Last updated:** 03/06/2019