Healthcare Provider Details

I. General information

NPI: 1275024515
Provider Name (Legal Business Name): NOELLE WALDSCHMIDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 525
HARTFORD CT
06106-5525
US

IV. Provider business mailing address

85 SEYMOUR ST STE 525
HARTFORD CT
06106-5525
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-1908
  • Fax:
Mailing address:
  • Phone: 860-972-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR-11199
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number71084
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: