# MDLIVE MEDICAL GROUP DE PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MDLIVE MEDICAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992178115
- **Authorized official:** SUE-ANN ADRIANS (GOVERNMENT PROGRAMS PM)
- **Authorized official phone:** (945) 275-1345

## Contact information

- **Practice address:** 900 COTTAGE GROVE RD, BLOOMFIELD, CT 06002-2920
- **Practice address phone:** (800) 400-6354
- **Mailing address:** PO BOX 5006, HARTFORD, CT 06102-5006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RS0010X | Sports Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RS0010X | Sports Medicine (Internal Medicine) Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 11/10/2015
- **Last updated:** 05/12/2026