Healthcare Provider Details

I. General information

NPI: 1013969419
Provider Name (Legal Business Name): NEW LONDON FAMILY PRACTICE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 W MAIN ST
NEW LONDON OH
44851-1018
US

IV. Provider business mailing address

187 W MAIN ST
NEW LONDON OH
44851-1018
US

V. Phone/Fax

Practice location:
  • Phone: 419-929-4357
  • Fax: 419-929-0814
Mailing address:
  • Phone: 419-929-4357
  • Fax: 419-929-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY A HARWOOD
Title or Position: OWNER
Credential: M.D.
Phone: 419-929-4357