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General NPI Number Information
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NPI Number | 1073558508
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Entity Type | Organization
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Legal Business Name | MERIDEN-WALLINGFORD ANESTHESIA GROUP PC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 435 LEWIS AVE
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City | MERIDEN
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State | CT
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Zip | 06451-2101
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Country | US
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Telephone | 203-694-8200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 744473
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City | ATLANTA
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State | GA
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Zip | 30374-4473
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Country | US
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Telephone | 107-355-8508
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Fax | 913-242-6850
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Authorized Official
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Title or Position | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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