Roy A. Kellerman, Md, Llc | |
701 Cottage Grove Rd Ste A110 Bloomfield CT 06002-3082 | |
(860) 243-5569 | |
(860) 243-2622 |
Full Name | Roy A. Kellerman, Md, Llc |
---|---|
Speciality | Internal Medicine |
Location | 701 Cottage Grove Rd Ste A110, Bloomfield, Connecticut |
Authorized Official Name and Position | Roy A Kellerman (DOCTOR) |
Authorized Official Contact | 8602435569 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Roy A. Kellerman, Md, Llc 701 Cottage Grove Rd Ste A110 Bloomfield CT 06002-3082 Ph: (860) 243-5569 | Roy A. Kellerman, Md, Llc 701 Cottage Grove Rd Ste A110 Bloomfield CT 06002-3082 Ph: (860) 243-5569 |
NPI Number | 1336314475 |
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Provider Enumeration Date | 04/29/2008 |
Last Update Date | 08/02/2010 |
Medicare PECOS PAC ID | 1658366349 |
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Medicare Enrollment ID | O20040420001212 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336314475 | NPI | - | NPPES |
010023862CT05 | Other | CT | BC/BS |
110008097 | Other | CT | MEDICARE |
001238625 | Medicaid | CT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 23862 (Connecticut) | Primary |
Provider Name | Roy A Kellerman |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1083780605 PECOS PAC ID: 6800881590 Enrollment ID: I20120619000000 |
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