Organization
MYSTIC MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS MARCH BLUM M.D. (PRESIDENT)
(860) 572-8911
Entity
Organization
Contact information
Practice address
200 SANDY HOLLOW RD, MYSTIC, CT 06355-1720
(860) 572-8911
(860) 572-7758
Mailing address
200 SANDY HOLLOW RD, MYSTIC, CT 06355-1720
(860) 572-8911
(860) 572-7758
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004002861
—
CT
Enumeration date
09/15/2005
Last updated
12/22/2009
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