MAIN MEDICAL-MYSTIC, LLC (NPI# 1003001850) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003001850 |
| Entity Type | Organization |
| Organization Name | MAIN MEDICAL-MYSTIC, LLC |
| Practice Address |
23 Clara Dr Suite 201 Mystic CT 06355-1959 |
| Practice Telephone | 8605361666 |
| Practice Fax Number | 8605369770 |
| Mailing Telephone | 8605361666 |
| Mailing Fax Number | 8605369770 |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2007-09-13 |
| Authorized Official Name | DR. ROY MARTIN MAIN (OWNER/PHYSICIAN) |
| Authorized Official Telephone | 8605361666 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 031865 | CT | Allopathic & Osteopathic Physicians |
| Street Address |
23 CLARA DR SUITE 201 |
| City | MYSTIC |
| State | CT |
| Zip Code | 06355-1959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316924749 | Doron J Ber | Allergy & Immunology | 23 Clara Dr, Suite 204, Mystic, CT 06355-1959 | 2005-12-28 |
| 1528236932 | Gabrielle Eden Pierce | Physician Assistant | 23 Clara Dr, Suite 201, Mystic, CT 06355-1959 | 2008-02-19 |
| 1013195064 | Laura Ann White | Optometrist | 23 Clara Dr, Visions Sight and Learning Center, Mystic, CT 06355 | 2008-02-01 |
| 1467659227 | Adrienne Lynne Marold Parad | Family Medicine | 23 Clara Dr, Suite 203, Mystic, CT 06355-1959 | 2007-06-27 |
| 1811109259 | Coastal Chiropractic & Family Wellness Centre | Chiropractor | 23 Clara Dr, Suite 105, Mystic, CT 06355-1959 | 2007-05-06 |
| 1942424551 | Mahesh Anil Netravali | Allergy & Immunology | 23 Clara Dr, Suite 204, Mystic, CT 06355-1959 | 2007-04-13 |
| 1265656946 | Jennifer Felicelli | Physician Assistant | 23 Clara Dr, Mystic, CT 06355-1959 | 2007-04-12 |
| 1558406066 | Daniel Leroy Waggoner | Allergy & Immunology | 23 Clara Dr, Suite 204, Mystic, CT 06355-1959 | 2007-02-21 |
| 1881757243 | Shoreline Allergy & Asthma Associates LLP | Allergy & Immunology | 23 Clara Dr, Suite 204, Mystic, CT 06355-1959 | 2006-12-18 |
| 1720065154 | Bruce A. Berlow | Specialist | 23 Clara Dr, Suite 204, Mystic, CT 06355-1959 | 2005-12-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770076069 | Brian Kristofer Owczarski | Physical Therapist | 80 Stonington Rd Ste A-3, Mystic, CT 06355 | 2018-06-11 |
| 1922554120 | Kayla Nickerson Gauthier | Marriage & Family Therapist | 41 Williams Ave, Mystic, CT 06355 | 2016-08-28 |
| 1417351156 | Lisa Pacifico | Physical Therapist | 44 Maritime Dive, Mystic, CT 06355 | 2014-10-09 |
| 1619386539 | Jennifer Rock | Occupational Therapist | 44 Maritime Drive, Pendleton Health and Rehab Center, Mystic, CT 06355 | 2014-08-05 |
| 1346565843 | Karen Lucille Hanscom | Psychologist | 47 Water St. #203, Mystic, CT 06355 | 2010-03-29 |
| 1346415627 | Eldon Richard Kilpatrick | Physical Therapy Assistant | 186 Jerry Browne Rd, Mystic, CT 06355 | 2008-04-28 |
| 1760688931 | Heather Elyse Geyer | Physical Therapist | 2440 Gold Star Hwy Suite 201, Mystic, CT 06355 | 2007-06-25 |
| 1982728754 | Falck Eye Center LLC | Ophthalmology | 35 Washington Street, Mystic, CT 06355 | 2007-03-19 |
| 1881724326 | Richard Irwin Steinberg | Dentist | 117 Cow Hill Road, Mystic, CT 06355 | 2007-03-06 |
| 1992890362 | Coastal Dermatology, P.C. | Dermatology | 55 Willow Street, Mystic, CT 06355 | 2006-10-03 |
| Find all providers in zip 06355 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154347250 | Edmund A P West | Internal Medicine | 56 Whitehall Ave, Rt 27, Mystic, CT 06355 | 2006-07-14 |
| 1194710210 | Thomas March Blum | Internal Medicine | 200 Sandy Hollow Rd, Mystic, CT 06355-1720 | 2005-09-14 |
| 1881780773 | Seaport Clinic LLC | Internal Medicine | 56 Whitehall Ave, Rt 27, Mystic, CT 06355 | 2006-10-05 |
| 1881610970 | Anne Maria Timmerman | Internal Medicine | 56 Whitehall Ave, Rt 27, Mystic, CT 06355 | 2006-07-14 |
| 1780679472 | James Francis Sullivan | Internal Medicine | 200 Sandy Hollow Rd, Mystic, CT 06355-1720 | 2005-09-19 |
| 1194710269 | James David Scarles | Internal Medicine | 200 Sandy Hollow Rd, Mystic, CT 06355-1720 | 2005-09-15 |
| 1821083999 | Warren Lewis Fields | Internal Medicine | 200 Sandy Hollow Rd, Mystic, CT 06355-1720 | 2005-09-15 |
| 1902891070 | Mystic Medical Group, PC | Internal Medicine | 200 Sandy Hollow Rd, Mystic, CT 06355-1720 | 2005-09-15 |
| 1346235462 | Rosemary Catherine Bontempi | Internal Medicine | 200 Sandy Hollow Rd, Mystic, CT 06355-1720 | 2005-09-14 |
| 1336134451 | Howard Brensilver | Internal Medicine | 200 Sandy Hollow Rd, Mystic, CT 06355-1720 | 2005-09-14 |
| Find all providers in MYSTIC | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.