Healthcare Provider Details

I. General information

NPI: 1619389541
Provider Name (Legal Business Name): MEREDITH HALSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 GRANITE ST STE C
NEW LONDON CT
06320-5945
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-8817
  • Fax: 860-442-2011
Mailing address:
  • Phone: 401-444-4471
  • Fax: 401-444-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP03064
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number66449
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: