Provider Demographics
NPI:1194204644
Name:AMARA PRIMARY CARE LLC
Entity Type:Organization
Organization Name:AMARA PRIMARY CARE LLC
Other - Org Name:MATTHEW AMARA, DO
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:AMARA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-740-4455
Mailing Address - Street 1:490 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06455-1210
Mailing Address - Country:US
Mailing Address - Phone:860-852-5828
Mailing Address - Fax:860-852-5833
Practice Address - Street 1:31 OLD ROUTE 7
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1711
Practice Address - Country:US
Practice Address - Phone:203-740-4455
Practice Address - Fax:203-740-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008081624Medicaid