Healthcare Provider Details

I. General information

NPI: 1710121389
Provider Name (Legal Business Name): RICHARD L. WINTERMUTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 ALBION ST SOUTHWEST COMMUNITY HEALTH CENTER, INC
BRIDGEPORT CT
06605-2602
US

IV. Provider business mailing address

510 CLINTON AVE SOUTHWEST COMMUNITY HEALTH CENTER, INC
BRIDGEPORT CT
06605-1701
US

V. Phone/Fax

Practice location:
  • Phone: 203-332-3155
  • Fax: 203-330-6008
Mailing address:
  • Phone: 203-336-4000
  • Fax: 203-382-2954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number52219
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: