Healthcare Provider Details

I. General information

NPI: 1619004975
Provider Name (Legal Business Name): PEDIATRIC MEDICINE OF WALLINGFORD LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 BARNES ROAD SUITE 6
WALLINGFORD CT
06492
US

IV. Provider business mailing address

97 BARNES ROAD SUITE 6 PEDIATRIC MEDICINE OF WALLINGFORD LLP
WALLINGFORD CT
06492
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-9890
  • Fax: 203-265-3321
Mailing address:
  • Phone: 203-265-9890
  • Fax: 203-265-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE M FRANK
Title or Position: PARTNER
Credential: MD
Phone: 203-265-9890