Provider Demographics
NPI:1518963495
Name:HEALY, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:HEALY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:79 WAWECUS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2160
Mailing Address - Country:US
Mailing Address - Phone:860-088-6267
Mailing Address - Fax:860-889-2862
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2160
Practice Address - Country:US
Practice Address - Phone:860-088-6267
Practice Address - Fax:860-889-2862
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT028849207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001288499Medicaid
CT001288499Medicaid
CT060000253Medicare PIN