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General NPI Number Information
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NPI Number | 1306905799
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Entity Type | Organization
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Legal Business Name | ANESTHESIA ASSOCIATES OF WILLIMANTIC PC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 1185 MAIN ST SUITE 2
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City | WILLIMANTIC
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State | CT
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Zip | 06226-2093
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Country | US
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Telephone | 860-423-7558
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Fax | 860-423-4694
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Provider Business Mailing Address
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Address Line | 1185 MAIN ST SUITE 2
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City | WILLIMANTIC
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State | CT
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Zip | 06226-2093
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Country | US
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Telephone | 860-423-7558
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Fax | 860-423-4694
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Authorized Official
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Title or Position | ANESTHESIOLOGIST
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Name | DR. ROBERT ADAM
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Credential | MD
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Telephone | 860-423-7558
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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 | 029636
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License Number State | CT
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