Roberto M Medina, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

034507 Issued in CT

Practice address

415 Silas Deane Hwy
Suite 210
Wethersfield, CT 06109-2124

Phone

(860) 257-4470

Fax

(860) 257-4479

NPI assigned

Jun 8, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dr. Roberto Medina, MD LLC

  • Primary Care Clinic/Center
  • Wethersfield, CT
  • NPI 1083798821

  Specialist

  NPD (past) Authorized official

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259625600000",
    "number": "1215977855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 SILAS DEANE HWY",
            "address_2": "SUITE 210",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "06109",
            "telephone_number": "860-257-4470",
            "fax_number": "860-257-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 SILAS DEANE HWY",
            "address_2": "SUITE 210",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061092124",
            "telephone_number": "860-257-4470",
            "fax_number": "860-257-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "ROBERTO",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2009-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CT",
            "license": "034507",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "034507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004220042",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Ann McKenna, MD
• Meredith Margaret McKeon, LPC
• Jennifer McNamara, PT
• Meaningful Journeys With Rebecca
• Medical Management Plus
• Sarah Mehigen, BCBA, LBA
• Tracee Joy Melendez, LCSW
• Mohammed A Memon, M.D.
• Anthea Mendez, APRN
• Kenneth A Merkatz, M.D.

• Internal Medicine Physician in Wethersfield, CT
• Providers in Wethersfield, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2009; 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.