Healthcare Provider Details

I. General information

NPI: 1952495087
Provider Name (Legal Business Name): GENERAL SURGICAL ASSOCIATES OF N.L., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 FAIR HARBOUR PL SUITE 2-C
NEW LONDON CT
06320-4731
US

IV. Provider business mailing address

50 FAIR HARBOUR PL SUITE 2-C
NEW LONDON CT
06320-4731
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-3147
  • Fax: 860-443-0087
Mailing address:
  • Phone: 860-443-3147
  • Fax: 860-443-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEAN NORMAN WILLIS
Title or Position: PRESIDENT/MD
Credential: M.D.
Phone: 860-443-3147