Provider Demographics
NPI:1346782224
Name:THE UROLOGY CLINIC OF GREENWICH PC
Entity Type:Organization
Organization Name:THE UROLOGY CLINIC OF GREENWICH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-863-1180
Mailing Address - Street 1:1385 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1305
Mailing Address - Country:US
Mailing Address - Phone:203-863-1180
Mailing Address - Fax:203-863-1182
Practice Address - Street 1:1385 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1305
Practice Address - Country:US
Practice Address - Phone:203-863-1180
Practice Address - Fax:203-863-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT31641208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50THEUROLCT01OtherANTHEM HEALTH PLANS
CTZS729OtherOXFORD HEALTH PLANS
CT50THEUROLCT01OtherANTHEM HEALTH PLANS