1154426377 NPI number — MICHELE TWIGG MD

Table of content: MICHELE TWIGG MD (NPI 1154426377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154426377 NPI number — MICHELE TWIGG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TWIGG
Provider First Name:
MICHELE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154426377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2110 SILAS DEANE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY HILL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06067-2313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-258-3480
Provider Business Mailing Address Fax Number:
860-571-6800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 E. GRANBY RD
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
GRANBY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-653-7261
Provider Business Practice Location Address Fax Number:
860-653-6639
Provider Enumeration Date:
09/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  039690 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)