| Silver Birch Md Llc | |
|
15 Palomba Dr Enfield CT 06082-3888 | |
| (860) 951-2198 | |
| Not Available |
| Full Name | Silver Birch Md Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 15 Palomba Dr, Enfield, Connecticut |
| Authorized Official Name and Position | Ian Sterling Tucker (OWNER/PHYSICIAN OWNER) |
| Authorized Official Contact | 8609512198 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Silver Birch Md Llc 71 W Stafford Rd Ste 4a Stafford Springs CT 06076-1069 Ph: () - | Silver Birch Md Llc 15 Palomba Dr Enfield CT 06082-3888 Ph: (860) 951-2198 |
| NPI Number | 1861208217 |
|---|---|
| Provider Enumeration Date | 12/09/2024 |
| Last Update Date | 12/09/2024 |
| Medicare PECOS PAC ID | 9739619370 |
|---|---|
| Medicare Enrollment ID | O20250211003481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861208217 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ian S Tucker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538130836 PECOS PAC ID: 8325015894 Enrollment ID: I20040914000656 |
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