Provider Demographics
NPI:1609063213
Name:INTERNAL MEDICINE OF MILFORD, P.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF MILFORD, P.C.
Other - Org Name:INTERNAL MEDICINE OF MILFORD
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D./VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:C
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-878-3531
Mailing Address - Street 1:40 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3535
Mailing Address - Country:US
Mailing Address - Phone:203-878-3531
Mailing Address - Fax:203-701-0389
Practice Address - Street 1:40 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3535
Practice Address - Country:US
Practice Address - Phone:203-878-3531
Practice Address - Fax:203-701-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207R00000X
CT207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11001594OtherMEDICARE GROUP NUMBER
CT4083036Medicaid
CT110001594Medicare PIN