Healthcare Provider Details

I. General information

NPI: 1023436029
Provider Name (Legal Business Name): PHYSICIANS FOR WOMEN'S HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CAPITAL BLVD STE 300
ROCKY HILL CT
06067-3914
US

IV. Provider business mailing address

175 CAPITAL BLVD STE 300
ROCKY HILL CT
06067-3914
US

V. Phone/Fax

Practice location:
  • Phone: 860-678-3400
  • Fax:
Mailing address:
  • Phone: 860-678-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateCT

VIII. Authorized Official

Name: MARK S DEFRANCESCO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 860-678-3400