Provider Demographics
NPI:1861689754
Name:LITCHFIELD COUNTY FAMILY PRACTICE
Entity Type:Organization
Organization Name:LITCHFIELD COUNTY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ISSAIC
Authorized Official - Last Name:SCHECTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-283-5223
Mailing Address - Street 1:131 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06787-1747
Mailing Address - Country:US
Mailing Address - Phone:860-283-5223
Mailing Address - Fax:860-283-7200
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1747
Practice Address - Country:US
Practice Address - Phone:860-283-5223
Practice Address - Fax:860-283-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03026Medicare PIN