Provider Demographics
NPI:1326139056
Name:LATSHAW, WENDY (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:LATSHAW
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 1:1131 WEST ST
Mailing Address - Street 2:BLDG 2
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-6006
Mailing Address - Country:US
Mailing Address - Phone:860-276-6800
Mailing Address - Fax:860-276-6801
Practice Address - Street 1:1131 WEST ST
Practice Address - Street 2:BLDG 2
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-6006
Practice Address - Country:US
Practice Address - Phone:860-276-6800
Practice Address - Fax:860-276-6801
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033004207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001330042Medicaid
CT001330042Medicaid
F62279Medicare UPIN