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General NPI Number Information
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NPI Number | 1760540397
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF NORWICH LLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/02/2007
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Provider Practice Location Address
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Address Line | 330 WASHINGTON ST SUITE 520
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City | NORWICH
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State | CT
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Zip | 06360
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Country | US
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Telephone | 860-889-3841
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Fax | 860-887-3840
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Provider Business Mailing Address
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Address Line | 330 WASHINGTON ST SUITE 520
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City | NORWICH
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State | CT
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Zip | 06360
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Country | US
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Telephone | 860-889-3841
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Fax | 860-887-3840
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KELLY J MARTIN
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Credential |
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Telephone | 860-889-3841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 030790
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 016369
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License Number State | CT
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