Healthcare Provider Details

I. General information

NPI: 1689638801
Provider Name (Legal Business Name): THOMAS W WINTERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GRAND ST
HARTFORD CT
06106-1541
US

IV. Provider business mailing address

21 GRAND ST
HARTFORD CT
06106-1541
US

V. Phone/Fax

Practice location:
  • Phone: 860-550-7500
  • Fax: 860-724-3190
Mailing address:
  • Phone: 860-550-7500
  • Fax: 860-724-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000227
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: