Provider Demographics
NPI:1275785214
Name:MEDICAL CARE CENTER OF EAST HARTFORD LLC
Entity Type:Organization
Organization Name:MEDICAL CARE CENTER OF EAST HARTFORD LLC
Other - Org Name:SILVER LANE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SULTAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:QURAISHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-569-7399
Mailing Address - Street 1:677 SILVER LN
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1257
Mailing Address - Country:US
Mailing Address - Phone:860-569-7399
Mailing Address - Fax:860-895-8107
Practice Address - Street 1:677 SILVER LN
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1257
Practice Address - Country:US
Practice Address - Phone:860-569-7399
Practice Address - Fax:860-895-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363LF0000X
CT030076208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004239168Medicaid
CT4245029OtherAETNA
CT010030076CT01OtherANTHEM
CTP3788258OtherOXFORD HEALTH PLANS
CT00000898346 15OtherUNITED HEALTH CARE
CT004239168Medicaid
CT2V7144OtherHEALTHNET
CT4245029OtherAETNA
CT206592OtherWELLCARE/PREFERRED ONE
CT2V7144OtherHEALTHNET