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NPI Code Detail

MEDICARE: NWCT EMERGENCY MEDICINE, PC

MEDICARE: NWCT EMERGENCY MEDICINE, PC
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
1363L00000XNurse PractitionerCT
2207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1500HBE262CT01OTHERBCBS
2628737OTHERCONNECTICARE

General Provider Information

NPI Number : 1831141563
Entity Type Code : Organization
Provider Name (Legal Business Name) : NWCT EMERGENCY MEDICINE, PC
Provider Business Mailing Address
First Line : PO BOX 1429
Second Line :
City : LITCHFIELD
State : CT
Zip : 06759-1429
Country : US
Telephone Number : 860-496-6435
Fax Number : 860-482-8627
Provider Business Practice Location Address
First Line : 540 LITCHFIELD ST
Second Line :
City : TORRINGTON
State : CT
Zip : 06790-6679
Country : US
Telephone Number : 860-496-6666
Fax Number :
Authorized Official
Title or Position : PRESIDENT/GENERAL PARTNER
Name : MARK R PRETE
Credential : MD
Telephone Number : 860-496-6435
Provider Enumeration Date : 05/17/2006
Last Update Date : 07/25/2012

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