Provider Demographics
NPI:1538287693
Name:MICHAEL J PIERCE MD LLC
Entity Type:Organization
Organization Name:MICHAEL J PIERCE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-657-8140
Mailing Address - Street 1:701 HEBRON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2489
Mailing Address - Country:US
Mailing Address - Phone:860-657-8140
Mailing Address - Fax:860-430-9403
Practice Address - Street 1:701 HEBRON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2489
Practice Address - Country:US
Practice Address - Phone:860-657-8140
Practice Address - Fax:860-430-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0335092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010033509CT04OtherANTHEM BLUE CROSS
CT010033509CT04OtherANTHEM BLUE CROSS