Provider Demographics
NPI:1427274844
Name:MDSERVICES, LLC
Entity type:Organization
Organization Name:MDSERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPC, BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSOLILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-758-1316
Mailing Address - Street 1:10 N BENSON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-3213
Mailing Address - Country:US
Mailing Address - Phone:203-758-1316
Mailing Address - Fax:203-758-1976
Practice Address - Street 1:10 N BENSON RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-3213
Practice Address - Country:US
Practice Address - Phone:203-758-1316
Practice Address - Fax:203-758-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC64840Medicare UPIN
CTQ37293Medicare UPIN
CTE91602Medicare UPIN