| Peter Licht M.d. & Jennifer Holloway M.d Llc. | |
|
172 Mount Pleasant Rd Newtown CT 06470-1443 | |
| (203) 426-8442 | |
| Not Available |
| Full Name | Peter Licht M.d. & Jennifer Holloway M.d Llc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 172 Mount Pleasant Rd, Newtown, Connecticut |
| Authorized Official Name and Position | Peter David Licht (MEMBER) |
| Authorized Official Contact | 2034268442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peter Licht M.d. & Jennifer Holloway M.d Llc. 172 Mount Pleasant Rd Newtown CT 06470-1443 Ph: (203) 426-8442 | Peter Licht M.d. & Jennifer Holloway M.d Llc. 172 Mount Pleasant Rd Newtown CT 06470-1443 Ph: (203) 426-8442 |
| NPI Number | 1528286895 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 10/18/2023 |
| Medicare PECOS PAC ID | 7517860802 |
|---|---|
| Medicare Enrollment ID | O20040202000910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528286895 | NPI | - | NPPES |
| 004260668 | Medicaid | CT | |
| DB9294 | Other | CT | RAILROAD MEDICAR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jennifer Holloway |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285601898 PECOS PAC ID: 2668375957 Enrollment ID: I20040203000042 |
| Provider Name | Peter Licht |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841267457 PECOS PAC ID: 8022911312 Enrollment ID: I20040203000051 |
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