Provider Demographics
NPI:1083808521
Name:NORTH STONINGTON MEDICAL WALK-IN CENTER, PC
Entity Type:Organization
Organization Name:NORTH STONINGTON MEDICAL WALK-IN CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:860-599-2469
Mailing Address - Street 1:82 NORWICH WESTERLY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359-1744
Mailing Address - Country:US
Mailing Address - Phone:860-599-2469
Mailing Address - Fax:860-599-2830
Practice Address - Street 1:82 NORWICH WESTERLY RD
Practice Address - Street 2:
Practice Address - City:NORTH STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06359-1744
Practice Address - Country:US
Practice Address - Phone:860-599-2469
Practice Address - Fax:860-599-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00935Medicare PIN