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General NPI Number Information
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NPI Number | 1063985323
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Entity Type | Organization
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Legal Business Name | WATERTOWN MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 365 MAIN ST STE 201
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City | WATERTOWN
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State | CT
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Zip | 06795-2249
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Country | US
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Telephone | 860-274-2418
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Fax | 860-274-2986
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Provider Business Mailing Address
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Address Line | 365 MAIN ST STE 201
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City | WATERTOWN
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State | CT
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Zip | 06795-2249
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Country | US
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Telephone | 860-274-2418
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Fax | 860-274-2986
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAXIMILIAN GOMEZ-TROCHEZ
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Credential | MD
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Telephone | 860-274-2418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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