Healthcare Provider Details

I. General information

NPI: 1457364564
Provider Name (Legal Business Name): JAMES A OUELLETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 JONES HOLLOW RD
MARLBOROUGH CT
06447-1448
US

IV. Provider business mailing address

4 FARM SPRINGS RD PROHEALTH PHYSICIANS
FARMINGTON CT
06032-2573
US

V. Phone/Fax

Practice location:
  • Phone: 860-295-8217
  • Fax: 860-295-9734
Mailing address:
  • Phone: 860-284-5200
  • Fax: 860-284-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number033867
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: