| Stafford Medical Group Llc | |
|
146 Main St Somers CT 06071-1825 | |
| (860) 749-8018 | |
| (860) 316-4015 |
| Full Name | Stafford Medical Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 146 Main St, Somers, Connecticut |
| Authorized Official Name and Position | Sultan Alam Quraishi (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8605583624 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stafford Medical Group Llc 146 Main St Somers CT 06071-1825 Ph: (860) 749-8018 | Stafford Medical Group Llc 146 Main St Somers CT 06071-1825 Ph: (860) 749-8018 |
| NPI Number | 1518098698 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 01/29/2015 |
| Medicare PECOS PAC ID | 0941100291 |
|---|---|
| Medicare Enrollment ID | O20040112000217 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518098698 | NPI | - | NPPES |
| 130076400 | Other | CT | BLUE CARE FAMILY PLAN |
| 010030076CT04 | Other | CT | ANTHEM |
| 4245029 | Other | CT | AETNA |
| 5861484 | Other | CT | CIGNA |
| HAS028 | Other | CT | OXFORD |
| 00000898346 | Other | CT | UNITED HEALTHCARE |
| 2V4565 | Other | CT | HEALTHNET |
| 217079 | Medicaid | CT | |
| 781160 | Other | CT | CONNECTICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 30076 (Connecticut) | Primary |
| 208600000X | Surgery | 30076 (Connecticut) | Secondary |
| 363L00000X | Nurse Practitioner | 5393 (Connecticut) | Secondary |
| Provider Name | Misbah M Vahidy |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1164461091 PECOS PAC ID: 8628962602 Enrollment ID: I20040211000068 |
| Provider Name | Sultan A Quraishi |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1144200122 PECOS PAC ID: 7214837590 Enrollment ID: I20081212000554 |
| Provider Name | Srinivasulu Conjeevaram |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780958058 PECOS PAC ID: 6103054655 Enrollment ID: I20150709000399 |
| Provider Name | Vrunda J Shah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891242004 PECOS PAC ID: 5193007623 Enrollment ID: I20170118001763 |
| Provider Name | Suzanne Viger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760957526 PECOS PAC ID: 8628322278 Enrollment ID: I20181116001661 |
| Provider Name | Jennifer Anne Briggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255878773 PECOS PAC ID: 8022169226 Enrollment ID: I20181205000135 |
Somers Family Practice, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 24 Battle Street, Suite 1a, Somers, CT 06071 Phone: 860-749-8887 Fax: 860-749-7421 |