Healthcare Provider Details

I. General information

NPI: 1427045699
Provider Name (Legal Business Name): RAFAEL WURZEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 416 HARTFORD HEALTHCARE MEDICAL GROUP
HARTFORD CT
06106-5523
US

IV. Provider business mailing address

85 SEYMOUR ST STE 416 HARTFORD HEALTHCARE MEDICAL GROUP
HARTFORD CT
06106-5523
US

V. Phone/Fax

Practice location:
  • Phone: 860-947-8500
  • Fax: 860-524-8643
Mailing address:
  • Phone: 860-947-8500
  • Fax: 860-524-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number023487
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: