Provider Demographics
NPI:1427247923
Name:FAMILY MEDICAL CENTER LLC
Entity type:Organization
Organization Name:FAMILY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEKHAR
Authorized Official - Middle Name:CHANDRA
Authorized Official - Last Name:CHIRUNOMULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-452-0500
Mailing Address - Street 1:765 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2810
Mailing Address - Country:US
Mailing Address - Phone:203-452-0500
Mailing Address - Fax:203-452-0300
Practice Address - Street 1:765 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2810
Practice Address - Country:US
Practice Address - Phone:203-452-0500
Practice Address - Fax:203-452-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty