NPI 1902891070

Mystic Medical Group, PC

Organisation Internal Medicine Physician Mystic, CT

Practice location

Address: 200 Sandy Hollow Rd, Mystic, CT 06355-1720
Phone: (860) 572-8911
Fax: (860) 572-7758

Authorised official

Name: Thomas March Blum
Title: President
Phone: (860) 572-8911

Registered specialties

Internal Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207R00000X

Other Internal Medicine providers in Connecticut →

Registry record

NPI: 1902891070
Entity type: Organization
NPI issued: 15 Sep 2005
Record last updated: 22 Dec 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.