Main Medical-Mystic, LLC
Organization Active NPI Internal Medicine Physician · Mystic, CT
NPI 1003001850 · NPPES record last updated Sep 13, 2007
Key facts
- NPI
- 1003001850
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 031865 (CT)
- Legal business name
- MAIN MEDICAL-MYSTIC, LLC
- Practice address
- 23 Clara Dr
Suite 201
Mystic, CT 06355-1959 - Phone
- (860) 536-1666
- Fax
- (860) 536-9770
- NPI assigned
- Sep 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Roy Martin Main, M.D.
- Title
- Owner/Physician
- Phone
- (860) 536-1666
Practitioners 8
-
Michael William Allard, D.C.
-
Jennifer Felicelli, PA-C
-
Warren M Geruso, DC
-
Joseph A Mascaro, DC
-
Gabrielle Eden Pierce, PA-C
-
Michael Thomas, DC
-
Sukhjinder Khera, M.D.
National Provider Directory
Locations
23 Clara Dr
Ste 201
Mystic, CT 06355
Phone (860) 536-1666
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 031865 | CT | Yes |
Addresses
Primary practice location
23 Clara Dr
Suite 201
Mystic, CT 06355-1959
Mailing address
23 Clara Dr
Suite 201
Mystic, CT 06355-1959
Phone (860) 536-1666
Other providers in Mystic, CT
- Life Balance Counseling CT, LLC
- Kristin J. Lincoln
- Annie Lion-Lee
- Michael Lopes
- Margaret M Loughlin
- Dawn Manferdini
- Suzanne Manzo
- Kathleen Fitzgerald Maranda
- Madison Marcavage
- Jennifer Anne Martley
All providers in Mystic, CT · Internal Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.