Active NPI
Frederic Taylor Mauck, M.D.
- Pediatrics Physician
- Farmington, CT
National Provider Identifier
1497094924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 011113
- Practice address
- 12 Porter Rd
Farmington, CT 06032-2221 - Phone
- (860) 677-2474
- NPI assigned
- Feb 4, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 011113 | CT | Primary |
Addresses
Primary practice location
12 Porter Rd
Farmington, CT 06032-2221
Mailing address
12 Porter Road
Farmington, CT 06032
Phone (860) 677-2474
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011113 | CT | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360108800000",
"number": "1497094924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 PORTER ROAD",
"city": "FARMINGTON",
"state": "CT",
"postal_code": "06032",
"telephone_number": "860-677-2474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 PORTER RD",
"city": "FARMINGTON",
"state": "CT",
"postal_code": "060322221",
"telephone_number": "860-677-2474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAUCK",
"first_name": "FREDERIC",
"middle_name": "TAYLOR",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-02-04",
"last_updated": "2013-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CT",
"license": "011113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.