Provider Demographics
NPI:1346412053
Name:STORRS FAMILY MEDICINE
Entity Type:Organization
Organization Name:STORRS FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMAIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-429-9321
Mailing Address - Street 1:1022 STORRS RD
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2639
Mailing Address - Country:US
Mailing Address - Phone:860-429-9321
Mailing Address - Fax:860-429-4775
Practice Address - Street 1:1022 STORRS RD
Practice Address - Street 2:
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06268-2639
Practice Address - Country:US
Practice Address - Phone:860-429-9321
Practice Address - Fax:860-429-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty