| Internal Medicine Group Llc | |
|
1 Towne Park Plz Norwich CT 06360-2247 | |
| (860) 887-0010 | |
| (860) 887-0178 |
| Full Name | Internal Medicine Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1 Towne Park Plz, Norwich, Connecticut |
| Authorized Official Name and Position | Hanna Kackielo (OWNER) |
| Authorized Official Contact | 8608870010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine Group Llc 1 Towne Park Plz Norwich CT 06360-2247 Ph: (860) 887-0010 | Internal Medicine Group Llc 1 Towne Park Plz Norwich CT 06360-2247 Ph: (860) 887-0010 |
| NPI Number | 1770617367 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6204810401 |
|---|---|
| Medicare Enrollment ID | O20040615001607 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770617367 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | 037461 (Connecticut) | Primary |
| Provider Name | Hanna Kackielo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598714701 PECOS PAC ID: 0749264943 Enrollment ID: I20040616000583 |
| Provider Name | Julie Ann Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316299704 PECOS PAC ID: 3971756974 Enrollment ID: I20121226000001 |
| Provider Name | Jeanne Marie Harrington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194452599 PECOS PAC ID: 0547638546 Enrollment ID: I20221123000580 |
| Provider Name | Elizabeth Devlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346760253 PECOS PAC ID: 7315292232 Enrollment ID: I20230131001693 |
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