Provider Demographics
NPI:1184834418
Name:G. WALSH & M. COLLITON MD'S
Entity Type:Organization
Organization Name:G. WALSH & M. COLLITON MD'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-527-1669
Mailing Address - Street 1:19 WOODLAND ST
Mailing Address - Street 2:SUITE 45
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2372
Mailing Address - Country:US
Mailing Address - Phone:860-527-1669
Mailing Address - Fax:860-293-0783
Practice Address - Street 1:19 WOODLAND ST
Practice Address - Street 2:SUITE 45
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2372
Practice Address - Country:US
Practice Address - Phone:860-527-1669
Practice Address - Fax:860-293-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT021042OtherLICENSE
1063496883OtherNPI#
CT029475OtherLICENSE
1609853126OtherNPI #
CTC00770Medicare PIN
CT021042OtherLICENSE
E35361Medicare UPIN
CT029475OtherLICENSE
110000936Medicare ID - Type Unspecified