Healthcare Provider Details

I. General information

NPI: 1871789834
Provider Name (Legal Business Name): BONNIE MCGUIRE WRESCHNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE ROAD
GREENWICH CT
06830
US

IV. Provider business mailing address

5 PERRYRIDGE ROAD
GREENWICH CT
06830-4697
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-7926
  • Fax:
Mailing address:
  • Phone: 203-863-3637
  • Fax: 203-863-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number48258
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: