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General NPI Number Information
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NPI Number | 1982775276
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Entity Type | Organization
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Legal Business Name | WATERBURY ORTHOPAEDIC ASSOCIATES P C
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 1211 W MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06708-3106
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Country | US
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Telephone | 203-755-0163
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Fax | 203-574-5894
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Provider Business Mailing Address
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Address Line | 1211 W MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06708-3106
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Country | US
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Telephone | 203-755-0163
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Fax | 203-574-5894
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC JON OLSON
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Credential | M.D.
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Telephone | 203-755-0163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | CT
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Taxonomy #7
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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