Provider Demographics
NPI:1285630798
Name:ROCKWELL, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:ROCKWELL
Suffix:
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 1:4675 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1813
Mailing Address - Country:US
Mailing Address - Phone:203-374-6103
Mailing Address - Fax:203-374-1663
Practice Address - Street 1:4675 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1813
Practice Address - Country:US
Practice Address - Phone:203-374-6103
Practice Address - Fax:203-374-1663
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017143207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1171438Medicaid
CT0V0522OtherHEALTH NET
CT01-0017143CT01OtherANTHEM BLUE CROSS/BLUE SH
CTP381229OtherOXFORD
CT01-0017143CT01OtherANTHEM BLUE CROSS/BLUE SH
CT0V0522OtherHEALTH NET