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General NPI Number Information
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NPI Number | 1508085101
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Entity Type | Organization
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Legal Business Name | WILLIAM R. MARON MD PC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 21 WOODLAND ST SUITE 222
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City | HARTFORD
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State | CT
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Zip | 06105-4318
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Country | US
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Telephone | 860-522-5215
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Fax | 860-247-3347
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Provider Business Mailing Address
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Address Line | 21 WOODLAND ST SUITE 222
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City | HARTFORD
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State | CT
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Zip | 06105-4318
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Country | US
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Telephone | 860-522-5215
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Fax | 860-247-3347
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM R MARON
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Credential | MD
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Telephone | 860-522-5215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 018676
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License Number State | CT
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