NPIMap

Organization Active NPI

Mdlive Medical Group PA

  • Dermatology Physician
  • Bloomfield, CT
National Provider Identifier
1831807973
Registry record updated May 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MDLIVE MEDICAL GROUP PA
Practice address
900 Cottage Grove Rd
Bloomfield, CT 06002-2920
Phone
(800) 400-6354
NPI assigned
Nov 8, 2022
Organization subpart
Yes
Parent organization
MDLIVE MEDICAL GROUP PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 4, 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
(945) 275-1345

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

900 Cottage Grove Rd
Bloomfield, CT 06002-2920

Mailing address

PO Box 5006
Hartford, CT 06102-5006

National Provider Directory

National Provider Directory
Tax ID family
Mdlive Medical Group PA4 organizations share this tax ID, including this one
Part of
Mdlive Medical Group PA

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": "1667865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777852800000",
    "number": "1831807973",
    "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 PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MDLIVE MEDICAL GROUP PA",
        "enumeration_date": "2022-11-08",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A",
        "authorized_official_last_name": "ADRIANS",
        "authorized_official_first_name": "SUE-ANN",
        "authorized_official_title_or_position": "GP PM",
        "authorized_official_telephone_number": "945-275-1345"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 May 4, 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.