Medina, Roberto M
Medina, Roberto M is an sole proprietor health care provider with primary practice located at 415 Silas Deane Hwy Suite 210, Wethersfield CT 06109-2124. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Medina, Roberto M can be contacted via phone (860) 257-4470.Contact Information
Primary practice address
415 Silas Deane Hwy Suite 210
Wethersfield CT 06109-2124
Phone: (860) 257-4470
Fax: (860) 257-4479
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 034507 | Connecticut |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 034507 | Connecticut |
Profile Details
| NPI number | 1215977855 |
|---|---|
| LBN Legal business name | Medina, Roberto M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 8th, 2006 |
| Last updated | Dec 1st, 2009 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215977855 | NPPES |
| Connecticut | MEDICAID | 004220042 |
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