Organization
MIDDLESEX HOSPITAL DBA FAMILY PRACTICE GROUP EAST HAMPTON
Active
Parent organization
MIDDLESEX HOSPITAL
Other names
Family Practice Group East Hampton
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIDDLESEX HOSPITAL
Authorized official
MARISA PELLERIN (CREDENTIALING/ENROLLMENT)
(860) 358-4821
Entity
Organization
Contact information
Practice address
42 E HIGH ST, EAST HAMPTON, CT 06424-1099
(860) 344-6394
(860) 344-6748
Mailing address
90 S MAIN ST, MIDDLETOWN, CT 06457-3649
(860) 358-6394
(860) 358-6094
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
CT
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
CT
207V00000X
Obstetrics & Gynecology Physician
—
CT
208000000X
Pediatrics Physician
—
CT
363AM0700X
Medical Physician Assistant
—
CT
Other
Enumeration date
02/20/2007
Last updated
03/06/2019
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