Healthcare Provider Details

I. General information

NPI: 1740445030
Provider Name (Legal Business Name): WILLIAM J. MCCANN M.D. P,C,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MAIN ST
OLD SAYBROOK CT
06475-2357
US

IV. Provider business mailing address

251 MAIN ST
OLD SAYBROOK CT
06475-2357
US

V. Phone/Fax

Practice location:
  • Phone: 860-388-1122
  • Fax: 860-388-1133
Mailing address:
  • Phone: 860-388-1122
  • Fax: 860-388-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM JOHN MCCANN
Title or Position: PRESIDENT
Credential:
Phone: 860-388-1122