Provider Demographics
NPI:1184896151
Name:GERIATRIC MEDICINE CONSULTANTS HOME VISIT PRACTICE, LLC
Entity type:Organization
Organization Name:GERIATRIC MEDICINE CONSULTANTS HOME VISIT PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-232-9741
Mailing Address - Street 1:33 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1009
Mailing Address - Country:US
Mailing Address - Phone:860-232-9741
Mailing Address - Fax:
Practice Address - Street 1:33 BIRCH RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1009
Practice Address - Country:US
Practice Address - Phone:860-232-9741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-30
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031718207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001317181Medicaid
CT1326174574OtherINDIVIDUAL NPI
CT1184896151OtherGROUP NPI
CTE861799Medicare UPIN
CTC03070Medicare PIN