Individual
ROBERTO M MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
415 SILAS DEANE HWY, SUITE 210, WETHERSFIELD, CT 06109-2124
(860) 257-4470
(860) 257-4479
Mailing address
415 SILAS DEANE HWY, SUITE 210, WETHERSFIELD, CT 06109
(860) 257-4470
(860) 257-4479
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
034507
CT
207R00000X
Internal Medicine Physician
Primary
034507
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004220042
—
CT
Enumeration date
06/08/2006
Last updated
12/01/2009
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