Organization
PRIORITY FAMILY HEALTHCARE OF NORTHEAST CONNECTICUT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAJA FATTALEH MD (OWNER)
(860) 928-1111
Entity
Organization
Contact information
Practice address
353 POMFRET ST, PUTNAM, CT 06260-1835
(860) 928-1111
Mailing address
PO BOX 333, PUTNAM, CT 06260-0333
(860) 928-1111
(860) 963-7756
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
038188
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001381889
—
CT
Enumeration date
07/23/2010
Last updated
01/15/2015
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