Manchester Pediatric Associates LLC
Organization Active NPI Pediatrics Physician · South Windsor, CT
NPI 1053612911 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1053612911
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 043564 (CT)
- Legal business name
- MANCHESTER PEDIATRIC ASSOCIATES LLC
- Practice address
- 2701 Tamarack Ave
South Windsor, CT 06074-5561 - Phone
- (860) 647-8282
- Fax
- (860) 647-8399
- NPI assigned
- Nov 9, 2010
- Organization subpart
- No
Authorized official
- Name
- Swathanthra Kumar Melekote, MD
- Title
- Owner
- Phone
- (860) 647-8282
Practitioners 11
-
Jennifer Bartson, CPNP-PC
-
Frederic Jacob Bernstein, D.O.
-
Andrea G. Dixon, MD
-
Tristin Elizabeth Geist, APRN
-
Gubbanna V Kumar, MD
-
Rachel Lynn Maclean, PA-C
-
Scott Michael O'Brien, PA-C
-
John Henry Walker, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D1085308 | Manchester Pediatric Associates | Certificate of waiver | Apr 17, 2027 |
| 07D2166888 | Manchester Pediatric Associates | Certificate of waiver | May 28, 2027 |
National Provider Directory
Locations
2701 Tamarack Ave
South Windsor, CT 06074
Phone (860) 375-5141
231 Merrow Rd
Ste 3915
Tolland, CT 06084
Phone (860) 875-9856
52 Peck Rd
Ste D
Torrington, CT 06790
Phone (860) 482-1170
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | 043564 | CT | Yes |
Addresses
Primary practice location
2701 Tamarack Ave
South Windsor, CT 06074-5561
Mailing address
2701 Tamarack Ave
South Windsor, CT 06074-5561
Phone (860) 647-8282
Other practice location 1
150 Hazard Ave Bldg B
Enfield, CT 06082-4587
Phone (860) 749-3661
Other practice location 2
130 Hartford Rd
Manchester, CT 06040-5921
Phone (860) 647-8282
Other practice location 3
89 West Rd Ste 1
Ellington, CT 06029-3718
Phone (860) 647-8282 ext. 108
Other practice location 4
52 Peck Rd Ste D
Torrington, CT 06790-6107
Phone (860) 482-1170
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629061965 | Medicaid | CT |
Other providers in South Windsor, CT
- Ameena Madan Paramasivan
- Christa Madden
- Emily Sarah Maloney
- Manchester Ear, Nose & Throat Center LLC
- Manchester Family Care LLC
- Mandell & Blau, MD'S PC
- Mandell & Blau, MD'S PC
- Laura Mandell
- Curtis Manganello
- Richard John Manganiello
All providers in South Windsor, CT · Pediatrics 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 Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.