Healthcare Provider Details

I. General information

NPI: 1760450886
Provider Name (Legal Business Name): E SPENCER JOSLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 RIVER RD
MIDDLETOWN CT
06457-3921
US

IV. Provider business mailing address

915 RIVER ROAD P.O. BOX 2797
MIDDLETOWN CT
06457-2797
US

V. Phone/Fax

Practice location:
  • Phone: 860-704-4045
  • Fax: 860-704-4301
Mailing address:
  • Phone: 860-704-4045
  • Fax: 860-704-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number037683
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number037683
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: