Provider Demographics
NPI:1306905799
Name:ANESTHESIA ASSOCIATES OF WILLIMANTIC PC
Entity type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF WILLIMANTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-423-7558
Mailing Address - Street 1:1185 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2093
Mailing Address - Country:US
Mailing Address - Phone:860-423-7558
Mailing Address - Fax:860-423-4694
Practice Address - Street 1:1185 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2093
Practice Address - Country:US
Practice Address - Phone:860-423-7558
Practice Address - Fax:860-423-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029636207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00230Medicare PIN