Provider Demographics
NPI:1003889767
Name:WILEY, CATHERINE CLINTON (MD)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:CLINTON
Last Name:WILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GRAND STREET
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-550-7500
Mailing Address - Fax:860-550-7501
Practice Address - Street 1:282 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-545-9300
Practice Address - Fax:860-545-9301
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034904208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT23808OtherCONTROLLED SUBSTANCE
CT004236007Medicaid
CT034904OtherPHYSICIAN SURGEON
E64084Medicare UPIN