Provider Demographics
NPI:1134591696
Name:SOUTHEASTERN CT PRIMARY CARE, LLC
Entity type:Organization
Organization Name:SOUTHEASTERN CT PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-691-8084
Mailing Address - Street 1:495 GOLD STAR HWY STE 112
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6229
Mailing Address - Country:US
Mailing Address - Phone:860-691-8084
Mailing Address - Fax:860-691-1195
Practice Address - Street 1:495 GOLD STAR HWY STE 112
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6229
Practice Address - Country:US
Practice Address - Phone:860-691-8084
Practice Address - Fax:860-691-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care