Healthcare Provider Details

I. General information

NPI: 1154032761
Provider Name (Legal Business Name): NORWICH ORTHOPEDIC GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AIRPORT RD
WESTERLY RI
02891-3432
US

IV. Provider business mailing address

82 NEW PARK AVE
NORTH FRANKLIN CT
06254-1807
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-7345
  • Fax:
Mailing address:
  • Phone: 860-885-7216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SARA GRACE
Title or Position: CREDENTIALING SPECIALIST
Credential: CPC-A
Phone: 860-885-7216