Colchester Family Medicine LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

041093 Issued in NU

Legal business name

COLCHESTER FAMILY MEDICINE LLC

Practice address

123 Broadway St
Colchester, CT 06415-1022

Phone

(860) 537-3204

Fax

(860) 537-3208

NPI assigned

Sep 6, 2007

Last updated

Aug 19, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Olawale Ayeni, MDNPI 1619079621

Title

Physician/Owner

Phone

(860) 537-3204

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Olawale Ayeni, MD

  • Family Medicine Physician
  • Colchester, CT
  • NPI 1619079621
  Authorized official Same address or phone

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219104000000",
    "number": "1952596579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 BROADWAY ST",
            "address_2": "P.O. BOX 288",
            "city": "COLCHESTER",
            "state": "CT",
            "postal_code": "064151022",
            "telephone_number": "860-537-3204",
            "fax_number": "860-537-3208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 BROADWAY ST",
            "city": "COLCHESTER",
            "state": "CT",
            "postal_code": "064151022",
            "telephone_number": "860-537-3204",
            "fax_number": "860-537-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLCHESTER FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2008-08-19",
        "status": "A",
        "authorized_official_last_name": "AYENI",
        "authorized_official_first_name": "OLAWALE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "860-537-3204",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": "041093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Lynn Colacicco, NUTRITIONIST
• Colchester Board of Education
• Colchester Center for Counseling LLC
• Colchester Counseling Associates, LLC
• Colchester Eye Care, LLC
• Colchester Internal Medicine, LLC
• Colchester Urgent Care Center LLC (The Urgent Care of Colchester)
• Coleman Pediatric Therapy LLC
• Community Medical Partners, Inc.
• Complete Care at Harrington Court LLC

• Primary Care Clinic/Center in Colchester, CT
• Providers in Colchester, CT by specialty
• Primary Care Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; 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.