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Organization
MHS PRIMARY CARE
Active
Organization
MHS PRIMARY CARE
Active
Other names
Coginchaug-Durham Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN SERKEY (NETWORK EXECUTIVE)
(860) 358-4802
Entity
Organization
Contact information
Practice address
6 MAIN ST., DURHAM, CT 06422
(860) 349-1058
(860) 358-8652
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4802
(860) 632-0240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
CT
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
04/25/2007
Last updated
01/20/2017
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