Judith M. Mascolo, Md, Llc | |
639 Park Rd Ste 100 West Hartford CT 06107-3443 | |
(860) 233-4600 | |
(860) 233-4604 |
Full Name | Judith M. Mascolo, Md, Llc |
---|---|
Speciality | Family Medicine |
Location | 639 Park Rd, West Hartford, Connecticut |
Authorized Official Name and Position | Judith M Mascolo (OWNER) |
Authorized Official Contact | 8602334600 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Judith M. Mascolo, Md, Llc 639 Park Rd Ste 100 West Hartford CT 06107-3443 Ph: (860) 233-4600 | Judith M. Mascolo, Md, Llc 639 Park Rd Ste 100 West Hartford CT 06107-3443 Ph: (860) 233-4600 |
NPI Number | 1043406812 |
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Provider Enumeration Date | 09/14/2007 |
Last Update Date | 04/28/2014 |
Medicare PECOS PAC ID | 6406943869 |
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Medicare Enrollment ID | O20071101000094 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043406812 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 036592 (Connecticut) | Primary |
Provider Name | Judith M Mascolo |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1972641801 PECOS PAC ID: 6507953965 Enrollment ID: I20071101000081 |
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