Organization
THE PEDIATRIC CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN ADEYINKA MD (OWNER)
(860) 589-4501
Entity
Organization
Contact information
Practice address
1301 FARMINGTON AVE, BRISTOL, CT 06010-4776
(860) 589-4501
(860) 589-4502
Mailing address
1301 FARMINGTON AVE, BRISTOL, CT 06010-4776
(860) 589-4501
(860) 589-4502
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
038949
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1389495
—
CT
Enumeration date
10/21/2016
Last updated
10/07/2020
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