Organization
MERCURY MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD ANDREW SEWELL MD (PRESIDENT)
(616) 690-1835
Entity
Organization
Contact information
Practice address
171 GROVE PL, WEST HAVEN, CT 06516-6438
(616) 690-1835
Mailing address
171 GROVE PL, WEST HAVEN, CT 06516-6438
(616) 690-1835
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
007163
CT
2084N0400X
Neurology Physician
045978
CT
2084P0800X
Psychiatry Physician
Primary
045978
CT
Other
Enumeration date
09/11/2012
Last updated
09/11/2012
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