Provider Demographics
NPI:1376095646
Name:BETHEL PRIMARY CARE CENTER LLC
Entity Type:Organization
Organization Name:BETHEL PRIMARY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:AMARA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-456-8000
Mailing Address - Street 1:6 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1053
Mailing Address - Country:US
Mailing Address - Phone:203-456-8000
Mailing Address - Fax:203-917-4923
Practice Address - Street 1:6 STONY HILL RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1053
Practice Address - Country:US
Practice Address - Phone:203-456-8000
Practice Address - Fax:203-917-4923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHEL PRIMARY CARE CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty