Provider Demographics
NPI:1568460228
Name:ADULT & PEDIATRIC UROLOGY OF NORTHWEST CONNECTICUT, P.C.
Entity Type:Organization
Organization Name:ADULT & PEDIATRIC UROLOGY OF NORTHWEST CONNECTICUT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEVANNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-496-8990
Mailing Address - Street 1:538 LITCHFIELD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-496-8990
Mailing Address - Fax:860-496-7301
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-496-8990
Practice Address - Fax:860-496-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========OtherTAFT HARTLEY (HMC) ID