Organization
GOLD STAR PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL BLEFELD (OWNER)
(860) 449-8882
Entity
Organization
Contact information
Practice address
495 GOLD STAR HWY, STE 495, GROTON, CT 06340-6228
(860) 449-8882
(860) 449-9195
Mailing address
495 GOLD STAR HWY, STE 120, GROTON, CT 06340-6228
(860) 449-8882
(860) 449-9195
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
22070
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004238227
—
CT
05
—
004395530
—
CT
Enumeration date
06/04/2007
Last updated
12/29/2008
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