Basic Information
| Provider Information | |||||||||
| NPI: | 1013061100 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINDHAM MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 IVAN HILL ST | ||||||||
| Address2: | |||||||||
| City: | WILLIMANTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062262001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604239764 | ||||||||
| FaxNumber: | 8604239866 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 IVAN HILL ST | ||||||||
| Address2: | |||||||||
| City: | WILLIMANTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062262001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604239764 | ||||||||
| FaxNumber: | 8604239866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOFFMAN | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8604235808 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 019808 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.