Provider Demographics
NPI:1730261389
Name:GUILFORD INTERNAL MEDICINE GROUP P.C.
Entity type:Organization
Organization Name:GUILFORD INTERNAL MEDICINE GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TORRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHWENTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-453-5062
Mailing Address - Street 1:385 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2003
Mailing Address - Country:US
Mailing Address - Phone:203-453-0361
Mailing Address - Fax:203-453-8510
Practice Address - Street 1:385 CHURCH ST
Practice Address - Street 2:SUITE101
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2003
Practice Address - Country:US
Practice Address - Phone:203-453-0361
Practice Address - Fax:203-453-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTS82621363AM0700X
CTP33210363AM0700X
CTS81603363L00000X
207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS82621Medicare UPIN
CTP33210Medicare UPIN
CTF64827Medicare UPIN
CTS81603Medicare UPIN
CTD98285Medicare UPIN