Provider Demographics
NPI:1225302136
Name:ORTHOPEDIC ASSOCIATES OF MIDDLETOWN, PC
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF MIDDLETOWN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-347-7636
Mailing Address - Street 1:512 SAYBROOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4788
Mailing Address - Country:US
Mailing Address - Phone:860-347-7636
Mailing Address - Fax:860-894-1894
Practice Address - Street 1:41 BREWSTER RD
Practice Address - Street 2:LEVEL D
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5161
Practice Address - Country:US
Practice Address - Phone:860-585-3040
Practice Address - Fax:860-585-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004186260Medicaid
CTC02315Medicare PIN