MEDICARE: ADULT & PEDIATRIC UROLOGY OF NORTHWEST CONNECTICUT, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1568460228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT & PEDIATRIC UROLOGY OF NORTHWEST CONNECTICUT, P.C.

Provider Business Mailing Address
First Line	:	538 LITCHFIELD ST
Second Line	:	SUITE 102
City	:	TORRINGTON
State	:	CT
Zip	:	06790-6669
Country	:	US
Telephone Number	:	860-496-8990
Fax Number	:	860-496-7301

Provider Business Practice Location Address
First Line	:	538 LITCHFIELD ST
Second Line	:	SUITE 102
City	:	TORRINGTON
State	:	CT
Zip	:	06790-6669
Country	:	US
Telephone Number	:	860-496-8990
Fax Number	:	860-496-7301

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES F. DEVANNEY
Credential	:	M.D.
Telephone Number	:	860-496-8990

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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