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Organization

EAST GRANBY FAMILY PRACTICE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. STEVEN R DIETRICH MD (PARTNER MD)
(860) 653-4526
Entity
Organization

Contact information

Practice address
13 CHURCH RD, EAST GRANBY, CT 06026-0518
(860) 653-4526
(860) 653-5209
Mailing address
13 CHURCH RD, PO BOX 518, EAST GRANBY, CT 06026-0518
(860) 653-4526
(860) 653-5209

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
363LF0000X
Family Nurse Practitioner

Other

Enumeration date
12/29/2005
Last updated
06/26/2013
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