Provider Demographics
NPI:1770558108
Name:DRECHSLER-MARTELL, CLIFF R (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFF
Middle Name:R
Last Name:DRECHSLER-MARTELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-0067
Mailing Address - Country:US
Mailing Address - Phone:860-347-0140
Mailing Address - Fax:860-346-3991
Practice Address - Street 1:324 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4435
Practice Address - Country:US
Practice Address - Phone:860-347-0140
Practice Address - Fax:860-346-3991
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001237767Medicaid
CT061127562OtherEIN
CT080000141Medicare PIN
CT061127562OtherEIN