Organization
FAMILY MEDICINE CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE LOUISE MACLEOD (OFFICE MANAGER)
(860) 646-4060
Entity
Organization
Contact information
Practice address
574 E MIDDLE TPKE, MANCHESTER, CT 06040-3730
(860) 646-4334
Mailing address
PO BOX 112, WINDSOR, CT 06095-0112
(860) 646-4334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA5952
RAILROAD MEDICARE
CT
Enumeration date
08/17/2007
Last updated
01/24/2008
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