Graduated: 2024
NPI: 1407689664
Practice Locations (2)
NORTHEAST MEDICAL GROUP INC
267 GRANT ST
BRIDGEPORT, CT 066102805
2033843000
BAYCARE MEDICAL GROUP, INC.
2727 W MLK JR BLVD, SUITE 460
TAMPA, FL 336076001
8138795010
Source: CMS National Downloadable File, September 2026.