Healthcare Provider Details

I. General information

NPI: 1992779912
Provider Name (Legal Business Name): JAMES P. WALDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 FARMINGTON AVE
BRISTOL CT
06010
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC CVO ENROLLMENT
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-516-5931
  • Fax:
Mailing address:
  • Phone: 860-972-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number033883
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number033883
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33883
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: