| Connecticut Coastal Metabolism, Llc | |
|
2068 Bridgeport Ave Milford CT 06460-4634 | |
| (203) 701-6787 | |
| (203) 693-2955 |
| Full Name | Connecticut Coastal Metabolism, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2068 Bridgeport Ave, Milford, Connecticut |
| Authorized Official Name and Position | Susan Wang (PRACTICE OWNER) |
| Authorized Official Contact | 2037016787 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Connecticut Coastal Metabolism, Llc 2068 Bridgeport Ave Milford CT 06460-4634 Ph: (203) 701-6787 | Connecticut Coastal Metabolism, Llc 2068 Bridgeport Ave Milford CT 06460-4634 Ph: (203) 701-6787 |
| NPI Number | 1730702705 |
|---|---|
| Provider Enumeration Date | 05/25/2020 |
| Last Update Date | 05/25/2020 |
| Medicare PECOS PAC ID | 9032535752 |
|---|---|
| Medicare Enrollment ID | O20200729002887 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730702705 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Susan M Wang |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1598880031 PECOS PAC ID: 0840388955 Enrollment ID: I20071126000487 |
| Provider Name | Rosanna Maria M Mendite |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295200020 PECOS PAC ID: 8224373436 Enrollment ID: I20181217001582 |
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