Provider Demographics
NPI:1003122011
Name:ADVANCED GYNECOLOGY CONSULTANTS OF NEW ENGLAND, LLC
Entity Type:Organization
Organization Name:ADVANCED GYNECOLOGY CONSULTANTS OF NEW ENGLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARCHIBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-963-0808
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-0569
Mailing Address - Country:US
Mailing Address - Phone:860-963-0808
Mailing Address - Fax:860-928-6738
Practice Address - Street 1:333 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1852
Practice Address - Country:US
Practice Address - Phone:860-963-0808
Practice Address - Fax:860-928-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036115207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty