Healthcare Provider Details

I. General information

NPI: 1912642323
Provider Name (Legal Business Name): THURBER THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BROAD ST STE 100
WINDSOR CT
06095-3030
US

IV. Provider business mailing address

127 CARRIAGE DR
GLASTONBURY CT
06033-3229
US

V. Phone/Fax

Practice location:
  • Phone: 860-368-1775
  • Fax:
Mailing address:
  • Phone: 860-368-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHENIE THURBER
Title or Position: OWNER
Credential: DO
Phone: 860-368-1775