| Wellington Provider Group Pc | |
|
1000 Lafayette Blvd Ste 1100 Bridgeport CT 06604-4710 | |
| (859) 518-8817 | |
| (859) 201-1084 |
| Full Name | Wellington Provider Group Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1000 Lafayette Blvd Ste 1100, Bridgeport, Connecticut |
| Authorized Official Name and Position | Mariela Bravo (CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 8595188817 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellington Provider Group Pc 535 Wellington Way Ste 330 Lexington KY 40503-1331 Ph: (859) 518-8817 | Wellington Provider Group Pc 1000 Lafayette Blvd Ste 1100 Bridgeport CT 06604-4710 Ph: (859) 518-8817 |
| NPI Number | 1043922321 |
|---|---|
| Provider Enumeration Date | 12/19/2022 |
| Last Update Date | 12/19/2022 |
| Medicare PECOS PAC ID | 8123412459 |
|---|---|
| Medicare Enrollment ID | O20230111000780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043922321 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kyle George |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982199519 PECOS PAC ID: 4688909690 Enrollment ID: I20230111001201 |
| Provider Name | Chirag Panchal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437654407 PECOS PAC ID: 1951651868 Enrollment ID: I20230124001060 |
| Provider Name | Carl Seger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699957308 PECOS PAC ID: 1951455773 Enrollment ID: I20230227001212 |
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