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General NPI Number Information
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NPI Number | 1609985654
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Entity Type | Organization
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Legal Business Name | JORGE DABDOUB MD INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 12 CASE ST SUITE 104
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City | NORWICH
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State | CT
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Zip | 06360-2222
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Country | US
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Telephone | 860-889-4476
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Fax | 860-889-6452
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Provider Business Mailing Address
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Address Line | 12 CASE ST SUITE 104
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City | NORWICH
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State | CT
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Zip | 06360-2222
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Country | US
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Telephone | 860-889-4476
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Fax | 860-889-6452
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Authorized Official
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Title or Position | OWNER
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Name | DR. JORGE A DABDOUB
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Credential | M.D.
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Telephone | 860-889-4476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 033578
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License Number State | CT
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