| Roy A. Kellerman, Md, Llc | |
|
701 Cottage Grove Rd Ste A110 Bloomfield CT 06002-3082 | |
| (860) 243-5569 | |
| (860) 243-2622 |
| Full Name | Roy A. Kellerman, Md, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 701 Cottage Grove Rd Ste A110, Bloomfield, Connecticut |
| Authorized Official Name and Position | Roy A Kellerman (DOCTOR) |
| Authorized Official Contact | 8602435569 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roy A. Kellerman, Md, Llc 701 Cottage Grove Rd Ste A110 Bloomfield CT 06002-3082 Ph: (860) 243-5569 | Roy A. Kellerman, Md, Llc 701 Cottage Grove Rd Ste A110 Bloomfield CT 06002-3082 Ph: (860) 243-5569 |
| NPI Number | 1336314475 |
|---|---|
| Provider Enumeration Date | 04/29/2008 |
| Last Update Date | 08/02/2010 |
| Medicare PECOS PAC ID | 1658366349 |
|---|---|
| Medicare Enrollment ID | O20040420001212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336314475 | NPI | - | NPPES |
| 010023862CT05 | Other | CT | BC/BS |
| 110008097 | Other | CT | MEDICARE |
| 001238625 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 23862 (Connecticut) | Primary |
| Provider Name | Roy A Kellerman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083780605 PECOS PAC ID: 6800881590 Enrollment ID: I20120619000000 |
David J Domenichini Md, Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 701 Cottage Grove Rd Ste B220, Bloomfield, CT 06002 Phone: 860-561-1007 Fax: 860-561-1222 | |
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