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MYSTIC MEDICAL ASSOCIATES LLC
NPI 1972954477
Clinic/Center - Primary Care in Mystic, CT

Active since June 27, 2016
12 ROOSEVELT AVE, SECOND FLOOR, MYSTIC, CT 06355(860) 245-4126(860) 245-4128 Get Directions Write a Review

NPPES record last updated: March 21, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Nov 9, 2022, Sep 13, 2022, Oct 30, 2020 and 2 more (5 updates tracked since 2016).

About Mystic Medical Associates Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MYSTIC MEDICAL ASSOCIATES LLC (NPI 1972954477) is a healthcare organization registered as a primary care in Mystic, Connecticut and active in the NPI registry since June 2016. The organization maintains a secondary practice location in Cheshire and lists Christopher J Anderson, Aprn, as its authorized official.

NPPES Registry Identity

NPI1972954477
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameMYSTIC MEDICAL ASSOCIATES LLC
Location Address12 ROOSEVELT AVE, SECOND FLOORMystic, CT 06355-2809
Mailing Address495 Gold Star Hwy Ste 112Groton, CT 06340-6229 · (860) 245-4126 · Fax (860) 245-4128
Phone(860) 245-4126
Fax(860) 245-4128
Organization SubpartNo
Authorized OfficialChristopher J AndersonAprn · (860) 245-4126
Enumeration DateJune 27, 2016
Last NPPES UpdateMarch 21, 20245 updates tracked since enumeration
NPPES CertifiedMarch 21, 2024
✔ NPI 1972954477 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X
12 ROOSEVELT AVE, Mystic, CT 06355
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Secondary Practice Location 1

Location 1230 S Main St., Suite #2Cheshire, CT 06410-0641 · Phone (860) 245-4126 · Fax (877) 927-0171

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CAROL SMITH PHD
Psychologist
12 ROOSEVELT AVE, APROMA STUDIOS
MYSTIC, CT 06355
Southeastern Connecticut Planning Region (860) 777-5560
DR. THOMAS JEFFREY WAGNER OD MS
Optometrist
12 ROOSEVELT AVE
MYSTIC, CT 06355
Southeastern Connecticut Planning Region (860) 536-1313
NATURA MEDICA
Naturopath
12 ROOSEVELT AVE
MYSTIC, CT 06355
Southeastern Connecticut Planning Region (860) 572-9566
ANNE RIVERS LCSW
Social Worker (Clinical)
12 ROOSEVELT AVE, SUITE 203
MYSTIC, CT 06355
Southeastern Connecticut Planning Region (860) 536-4383
SUSANNE G TAYLOR LMFT
Marriage & Family Therapist
12 ROOSEVELT AVE
MYSTIC, CT 06355
Southeastern Connecticut Planning Region (860) 899-7711
DR. MADLENE ESKAROSE
Dentist (General Practice)
12 ROOSEVELT AVE
MYSTIC, CT 06355
Southeastern Connecticut Planning Region (860) 572-0593
JEANNINE CLEAVER LCSW
Social Worker (Clinical)
12 ROOSEVELT AVE
MYSTIC, CT 06355
Southeastern Connecticut Planning Region (602) 459-8408
MS. LISA VENDITTO MA
Counselor (Professional)
12 ROOSEVELT AVE
MYSTIC, CT 06355
Southeastern Connecticut Planning Region (860) 333-4634

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mystic Medical Associates LLC's NPI number?

The NPI number for Mystic Medical Associates LLC is 1972954477. It was assigned to this organization in the NPPES registry on June 27, 2016.

Where is Mystic Medical Associates LLC located?

Mystic Medical Associates LLC is located at 12 Roosevelt Ave Second Floor, Mystic, CT 06355. The listed phone number is (860) 245-4126.

What is Mystic Medical Associates LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Mystic Medical Associates LLC was last updated on March 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.