Organization
QUINNIPIAC MEDICAL OF BRANFORD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KAY TAYLOR (OFFICE MANAGER)
(203) 488-6358
Entity
Organization
Contact information
Practice address
960 MAIN ST, BRANFORD, CT 06405-3730
(203) 488-6358
(203) 481-5327
Mailing address
960 MAIN ST, BRANFORD, CT 06405-3730
(203) 488-6358
(203) 481-5327
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004208931
—
CT
01
—
50QUINLLCT01
ANTHEM BCBS
CT
01
—
C02646
MEDICARE
CT
01
—
CH3185
RAILROAD MEDICARE
CT
Enumeration date
04/13/2006
Last updated
02/03/2022
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