Provider Demographics
NPI:1144229113
Name:MCPHEE, WALTER THOMAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:THOMAS
Last Name:MCPHEE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FOUNDERS ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226
Mailing Address - Country:US
Mailing Address - Phone:860-423-9764
Mailing Address - Fax:860-423-3115
Practice Address - Street 1:5 FOUNDERS ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2048
Practice Address - Country:US
Practice Address - Phone:860-423-9764
Practice Address - Fax:860-423-3115
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1175223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1175223OtherLICENSE NUMBER
CTD02855Medicare UPIN
110005099Medicare ID - Type Unspecified