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General NPI Number Information
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NPI Number | 1407126782
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Entity Type | Organization
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Legal Business Name | WINDHAM UROLOGY GROUP, PC
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 24 WINDHAM ST
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City | WILLIMANTIC
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State | CT
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Zip | 06226-2216
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Country | US
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Telephone | 860-423-5656
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Fax | 860-423-2122
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Provider Business Mailing Address
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Address Line | 24 WINDHAM ST
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City | WILLIMANTIC
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State | CT
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Zip | 06226-2216
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Country | US
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Telephone | 860-426-5656
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Fax | 860-423-2122
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Authorized Official
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Title or Position | PARTNER
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Name | JOHN N GRAHAM
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Credential | MD
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Telephone | 860-928-0819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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