Provider Demographics
NPI:1215099411
Name:EDWARD I WINOKUR MD
Entity type:Organization
Organization Name:EDWARD I WINOKUR MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:WINOKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-669-8659
Mailing Address - Street 1:27 COMMERCE STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413
Mailing Address - Country:US
Mailing Address - Phone:860-669-8659
Mailing Address - Fax:860-669-4382
Practice Address - Street 1:27 COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413
Practice Address - Country:US
Practice Address - Phone:860-669-8659
Practice Address - Fax:860-669-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI3521OtherRAILROAD MEDICARE
CT004239720Medicaid
CT004239720Medicaid