Provider Demographics
NPI:1386737625
Name:FAMILY PRACTICE OF LITCHFIELD COUNTY, L.L.C.
Entity type:Organization
Organization Name:FAMILY PRACTICE OF LITCHFIELD COUNTY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-482-6513
Mailing Address - Street 1:52 PECK RD
Mailing Address - Street 2:STE E
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6107
Mailing Address - Country:US
Mailing Address - Phone:860-482-6513
Mailing Address - Fax:860-489-7250
Practice Address - Street 1:52 PECK RD
Practice Address - Street 2:STE E
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6107
Practice Address - Country:US
Practice Address - Phone:860-482-6513
Practice Address - Fax:860-489-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001391169Medicaid
CT039116OtherSTATE LICENS NUMBER
CT30683OtherSTATE CONTR. SUBST. REG.
CTBG7206661OtherDEA NUMBER
CTBG7206661OtherDEA NUMBER
CT001391169Medicaid