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General NPI Number Information
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NPI Number | 1770867525
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Entity Type | Organization
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Legal Business Name | WINDHAM RHEUMATOLOGY, LLC
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 10 HIGGINS HWY SUITE 14
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1437
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Country | US
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Telephone | 860-456-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 10 HIGGINS HWY SUITE 14
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1437
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Country | US
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Telephone | 860-456-6105
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | IOANA C STANESCU
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Credential | M.D.
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Telephone | 860-456-6105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 36670
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License Number State | CT
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