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General NPI Number Information
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NPI Number | 1487436929
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC CENTER OF GLASTONBURY PLLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 78 EASTERN BLVD STE 6
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City | GLASTONBURY
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State | CT
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Zip | 06033-4325
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Country | US
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Telephone | 860-729-4682
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Fax |
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Provider Business Mailing Address
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Address Line | 78 EASTERN BLVD STE 6
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City | GLASTONBURY
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State | CT
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Zip | 06033-4325
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Country | US
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Telephone | 860-729-4682
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MICHAEL D WADDINGTON
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Credential | DO
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Telephone | 860-729-4862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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