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General NPI Number Information
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NPI Number | 1558477901
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Entity Type | Organization
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Legal Business Name | HEALTH ONE PHYSICIAN ASSOCIATES LLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 851 MARSHALL PHELPS ROAD
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City | WINDSOR
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State | CT
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Zip | 06095
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Country | US
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Telephone | 860-683-0756
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Fax | 860-683-1555
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Provider Business Mailing Address
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Address Line | 851 MARSHALL PHELPS ROAD
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City | WINDSOR
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State | CT
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Zip | 06095
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Country | US
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Telephone | 860-683-0756
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Fax | 860-683-1555
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Authorized Official
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Title or Position | MD/PARTNER
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Name | CHARLENE C LI
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Credential | MD
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Telephone | 860-683-0756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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