Healthcare Provider Details

I. General information

NPI: 1740205624
Provider Name (Legal Business Name): TERRY L RAMOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 TOLLAND TPKE
WILLINGTON CT
06279-1520
US

IV. Provider business mailing address

434 TOLLAND TPKE
WILLINGTON CT
06279-1520
US

V. Phone/Fax

Practice location:
  • Phone: 860-684-5015
  • Fax: 860-684-3749
Mailing address:
  • Phone: 860-684-5015
  • Fax: 860-684-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number037680
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: