Healthcare Provider Details

I. General information

NPI: 1780726026
Provider Name (Legal Business Name): THE WOMEN'S CENTER OF SOUTHERN NEW ENGLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N MAIN STREET EXT BLDG 1, UNIT 1C
WALLINGFORD CT
06492-2400
US

IV. Provider business mailing address

850 N MAIN STREET EXT BLDG 1, UNIT 1C
WALLINGFORD CT
06492-2400
US

V. Phone/Fax

Practice location:
  • Phone: 203-269-0885
  • Fax: 203-269-3496
Mailing address:
  • Phone: 203-269-0885
  • Fax: 203-269-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number037129
License Number StateCT

VIII. Authorized Official

Name: DR. ANDREW METZGER
Title or Position: OWNER
Credential: M.D.
Phone: 203-269-0885