NPIMap

Organization Active NPI

Mdlive Medical Group NM, LLC

  • Dermatology Physician
  • Bloomfield, CT
National Provider Identifier
1174201156
Registry record updated Apr 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MDLIVE MEDICAL GROUP NM, LLC
Practice address
900 Cottage Grove Rd
Bloomfield, CT 06002-2920
Phone
(800) 400-6354
NPI assigned
Jul 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sue-Ann Adrians
Title
GP PM
Phone
(800) 400-6354

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

900 Cottage Grove Rd
Bloomfield, CT 06002-2920

Mailing address

PO Box 5006
Hartford, CT 06102-5006

Other names 1

  • MDLIVE MEDICAL GROUP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mdlive Medical Group4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775779200000",
    "number": "1174201156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5006",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061025006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 COTTAGE GROVE RD",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060022920",
            "telephone_number": "800-400-6354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDLIVE MEDICAL GROUP NM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-10",
        "last_updated": "2026-04-10",
        "certification_date": "2026-04-10",
        "status": "A",
        "authorized_official_last_name": "ADRIANS",
        "authorized_official_first_name": "SUE-ANN",
        "authorized_official_title_or_position": "GP PM",
        "authorized_official_telephone_number": "800-400-6354"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MDLIVE MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.