Provider Demographics
NPI:1083716203
Name:COLCHESTER INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:COLCHESTER INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ELISABETH
Authorized Official - Last Name:HYLWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-537-2262
Mailing Address - Street 1:199 OLD HARTFORD RD
Mailing Address - Street 2:UNIT #6
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-2739
Mailing Address - Country:US
Mailing Address - Phone:860-537-2262
Mailing Address - Fax:860-537-2273
Practice Address - Street 1:199 OLD HARTFORD RD
Practice Address - Street 2:UNIT #6
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-2739
Practice Address - Country:US
Practice Address - Phone:860-537-2262
Practice Address - Fax:860-537-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02710Medicare ID - Type Unspecified