MAIN MEDICAL-MYSTIC, LLC NPI 1003001850

Internal Medicine in Mystic, CT

About MAIN MEDICAL-MYSTIC, LLC

Main Medical-mystic, Llc is a provider in Mystic, CT. The NPI number assigned to this provider is 1003001850. The practitioner's primary taxonomy code is Internal Medicine (207R00000X). The provider is registered as an organization and their NPI record was last updated 10 years ago. Main Medical-mystic, Llc operates as a single speciality business group with one or more individual providers who practice the same area of specialization.

NPI1003001850 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameMAIN MEDICAL-MYSTIC, LLC
Provider Location Address23 CLARA DR SUITE 201 MYSTIC, CT 06355 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address23 CLARA DR SUITE 201 MYSTIC, CT 06355 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date09-13-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date09-13-2007 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

MAIN MEDICAL-MYSTIC, LLC
23 CLARA DR
SUITE 201
MYSTIC, CT
ZIP 06355
Phone: (860) 536-1666
Fax: (860) 536-9770
Get Directions

Mailing Address

MAIN MEDICAL-MYSTIC, LLC
23 CLARA DR
SUITE 201
MYSTIC, CT
ZIP 06355
Phone: (860) 536-1666
Fax: (860) 536-9770

Primary Taxonomy

Taxonomy Code207R00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
License No.031865
License StateCT
Taxonomy DescriptionA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Authorized Official

Authorized Official NameDR. ROY MARTIN MAIN M.D. Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleOWNER/PHYSICIAN
Authorized Official Phone(860) 536-1666

193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
C02861MEDICARE PIN (08)CT
B30093MEDICARE UPIN (02)CT

Map Location


MAIN MEDICAL-MYSTIC, LLC address is 23 CLARA DR SUITE 201 MYSTIC, CT 06355

Other Providers at the same location


The following 10 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1013195064MRS. LAURA ANN WHITE OTRL
Individual
Occupational Therapist23 CLARA DR VISIONS SIGHT AND LEARNING CENTER
MYSTIC, CT 06355
(860) 572-4805
1265656946 JENNIFER FELICELLI PA-C
Individual
Physician Assistant23 CLARA DR
MYSTIC, CT 06355
(860) 536-1666
1316924749 DORON J BER M.D.
Individual
Allergy & Immunology (Allergy)23 CLARA DR SUITE 204
MYSTIC, CT 06355
(860) 536-2995
1467659227DR. ADRIENNE LYNNE MAROLD PARAD M.D.
Individual
Family Medicine23 CLARA DR SUITE 203
MYSTIC, CT 06355
(860) 464-2028
1528236932MRS. GABRIELLE EDEN PIERCE PA-C
Individual
Physician Assistant23 CLARA DR SUITE 201
MYSTIC, CT 06355
(860) 536-1666
1558406066 DANIEL LEROY WAGGONER M.D.
Individual
Allergy & Immunology23 CLARA DR SUITE 204
MYSTIC, CT 06355
(860) 536-2995
1720065154 BRUCE A. BERLOW M.D.
Individual
Specialist23 CLARA DR SUITE 204
MYSTIC, CT 06355
(860) 536-2995
1811109259COASTAL CHIROPRACTIC & FAMILY WELLNESS CENTRE
Organization
23 CLARA DR SUITE 105
MYSTIC, CT 06355
(860) 572-7711
1881757243SHORELINE ALLERGY & ASTHMA ASSOCIATES LLP
Organization
Allergy & Immunology (Allergy)23 CLARA DR SUITE 204
MYSTIC, CT 06355
(860) 536-2995
1942424551DR. MAHESH ANIL NETRAVALI M.D.
Individual
Allergy & Immunology23 CLARA DR SUITE 204
MYSTIC, CT 06355
(860) 536-2995