Mentalwellnessmd | |
45 S Main St Ste 302 West Hartford CT 06107-2402 | |
(860) 698-3600 | |
Not Available |
Full Name | Mentalwellnessmd |
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Speciality | Internal Medicine |
Location | 45 S Main St Ste 302, West Hartford, Connecticut |
Authorized Official Name and Position | Thomas Brown (SOLE MEMBER) |
Authorized Official Contact | 8606983600 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mentalwellnessmd 45 S Main St Ste 302 West Hartford CT 06107-2402 Ph: (860) 698-3600 | Mentalwellnessmd 45 S Main St Ste 302 West Hartford CT 06107-2402 Ph: (860) 698-3600 |
NPI Number | 1609495134 |
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Provider Enumeration Date | 04/14/2020 |
Last Update Date | 10/12/2021 |
Medicare PECOS PAC ID | 5294131652 |
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Medicare Enrollment ID | O20210909002626 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609495134 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Thomas A Brown |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1053402263 PECOS PAC ID: 0941301774 Enrollment ID: I20070724000542 |
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