Provider Demographics
NPI:1407054794
Name:MATHEWS, REMI (MD)
Entity Type:Individual
Prefix:DR
First Name:REMI
Middle Name:
Last Name:MATHEWS
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 1:11 OXFORD CT
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2174
Mailing Address - Country:US
Mailing Address - Phone:860-651-8250
Mailing Address - Fax:
Practice Address - Street 1:130 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5921
Practice Address - Country:US
Practice Address - Phone:860-533-4673
Practice Address - Fax:860-812-0305
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001455949Medicaid
CT001455949Medicaid