Provider Demographics
NPI:1346515657
Name:LE, MAURA TEMCHIN (MD)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:TEMCHIN
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E MAIN ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2911
Mailing Address - Country:US
Mailing Address - Phone:203-481-5665
Mailing Address - Fax:
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2911
Practice Address - Country:US
Practice Address - Phone:203-481-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine