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MANCHESTER PEDIATRIC ASSOCIATES LLC NPI 1053612911


NPI Information

NPI: 1053612911
Provider Name: MANCHESTER PEDIATRIC ASSOCIATES LLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 07D1085308

Address:
2701 TAMARACK AVE
SOUTH WINDSOR, CT
ZIP 06074
Phone: (860) 647-8282
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MANCHESTER PEDIATRIC ASSOCIATES LLC is a pediatrics in South Windsor, CT. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. MANCHESTER PEDIATRIC ASSOCIATES LLC NPI is 1053612911. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2701 TAMARACK AVE
SOUTH WINDSOR, CT
ZIP 06074-561
Phone: (860) 647-8282
Fax: (860) 647-8399

The provider's authorized official is Swathanthra Kumar Melekote .
The authorized official title is Owner and has the following contact phone number (860) 647-8282.

The CLIA number assigned to this NPI record is 07D1085308 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/9/2010 and was last updated on 3/17/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics043564CONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11629061965MEDICAIDCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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