Provider Demographics
NPI:1407211303
Name:TRANSLATIONAL MEDICINE CLINIC & RESEARCH CENTER
Entity Type:Organization
Organization Name:TRANSLATIONAL MEDICINE CLINIC & RESEARCH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-477-0961
Mailing Address - Street 1:48 MOOSUP VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:RI
Mailing Address - Zip Code:02825-1236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1768 STORRS RD
Practice Address - Street 2:SUITE A
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-1260
Practice Address - Country:US
Practice Address - Phone:860-477-0961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center