Provider Demographics
NPI:1366439036
Name:ELWELL, ROBERT W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:ELWELL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:22 MASONIC AVE.
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-679-5900
Mailing Address - Fax:203-679-6873
Practice Address - Street 1:22 MASONIC AVE.
Practice Address - Street 2:1ST FLR
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-679-5900
Practice Address - Fax:203-679-6873
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2010-01-20
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Provider Licenses
StateLicense IDTaxonomies
CT21753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1217538Medicaid
CT4239676OtherAETNA
CT010021753CT01OtherANTHEM BC OF CT
CT061043813002OtherCIGNA
CT021753OtherCONNECTICARE
CTOR4598OtherHEALTH NET
CTP400371OtherOXFORD
CAC59757Medicare UPIN
CTOR4598OtherHEALTH NET