Healthcare Provider Details

I. General information

NPI: 1356433486
Provider Name (Legal Business Name): WINDSOR LOCKS MEDICAL CENTER, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 OLD COUNTY ROAD
WINDSOR LOCKS CT
06096
US

IV. Provider business mailing address

73 OLD COUNTY ROAD
WINDSOR LOCKS CT
06096
US

V. Phone/Fax

Practice location:
  • Phone: 860-627-0161
  • Fax: 860-292-1327
Mailing address:
  • Phone: 860-627-0161
  • Fax: 860-292-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number026154
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number026154
License Number StateCT

VIII. Authorized Official

Name: DR. WILLIAM BRUCE SPECTOR
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 860-627-0161