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Main Medical-Mystic, LLC

Internal Medicine in Mystic, CT. Organization (NPI-2).

NPI number1003001850
StatusActive
Last updated in NPPESSep 13, 2007

Details

NPI
1003001850
Entity type
Organization (NPI-2)
Legal business name
Main Medical-Mystic, LLC
Organization subpart
No
Enumeration date
Sep 13, 2007
Last updated
Sep 13, 2007

Medicare and OIG

Medicare enrolled (PECOS)
Not in the Medicare enrollment file
Can order and refer
Not on the CMS order and referring list
OIG exclusion list
This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine031865CTYes

Practice location

23 Clara Dr
Suite 201
Mystic, CT 06355-1959

Phone 860-536-1666 · Fax 860-536-9770

Mailing address

23 Clara Dr
Suite 201
Mystic, CT 06355-1959

Phone 860-536-1666 · Fax 860-536-9770

Authorized official

Roy Martin Main
Owner/Physician
8605361666

Is something wrong?

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Other Internal Medicine Physician providers in Mystic, CT

All 15 Internal Medicine Physician providers in Mystic · All 338 providers in Mystic

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