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General NPI Number Information
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NPI Number | 1972964989
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF CONNECTICUT
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 234 GLENBROOK RD UNIT 4011
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City | STORRS
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State | CT
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Zip | 06269-4011
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Country | US
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Telephone | 860-486-0730
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Fax | 860-486-4076
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Provider Business Mailing Address
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Address Line | 234 GLENBROOK RD UNIT 4011
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City | STORRS
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State | CT
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Zip | 06269-4011
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Country | US
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Telephone | 860-486-0730
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Fax | 860-486-4076
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JEFFREY ANDERSON
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Credential | M.D.
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Telephone | 860-486-0765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CL-0378
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License Number State | CT
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