| Priority Family Healthcare Of Northeast Connecticut, Llc | |
|
353 Pomfret St Putnam CT 06260-1835 | |
| (860) 928-1111 | |
| Not Available |
| Full Name | Priority Family Healthcare Of Northeast Connecticut, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 353 Pomfret St, Putnam, Connecticut |
| Authorized Official Name and Position | Raja Fattaleh (OWNER) |
| Authorized Official Contact | 8609281111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Priority Family Healthcare Of Northeast Connecticut, Llc Po Box 333 Putnam CT 06260-0333 Ph: (860) 928-1111 | Priority Family Healthcare Of Northeast Connecticut, Llc 353 Pomfret St Putnam CT 06260-1835 Ph: (860) 928-1111 |
| NPI Number | 1720391311 |
|---|---|
| Provider Enumeration Date | 07/23/2010 |
| Last Update Date | 01/15/2015 |
| Medicare PECOS PAC ID | 4688790801 |
|---|---|
| Medicare Enrollment ID | O20100924001083 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720391311 | NPI | - | NPPES |
| 001381889 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 038188 (Connecticut) | Primary |
| Provider Name | Raja Fattaleh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841283439 PECOS PAC ID: 7517932106 Enrollment ID: I20040827000438 |
| Provider Name | Sara E Garcia-gomes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467061655 PECOS PAC ID: 2062822612 Enrollment ID: I20201110001670 |
| Provider Name | Erin Gouldsbrough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447958780 PECOS PAC ID: 0749648020 Enrollment ID: I20230619000757 |
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