Healthcare Provider Details

I. General information

NPI: 1639220676
Provider Name (Legal Business Name): NORTHWEST HILLS PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 LITCHFIELD ST SUITE G-02
TORRINGTON CT
06790-6669
US

IV. Provider business mailing address

538 LITCHFIELD ST SUITE G-02
TORRINGTON CT
06790-6669
US

V. Phone/Fax

Practice location:
  • Phone: 860-489-5068
  • Fax: 860-489-3725
Mailing address:
  • Phone: 860-489-5068
  • Fax: 860-489-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD CARLETON KAVLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 860-489-5068