Provider Demographics
NPI:1710121389
Name:WINTERMUTE, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:WINTERMUTE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:510 CLINTON AVE
Mailing Address - Street 2:SOUTHWEST COMMUNITY HEALTH CENTER, INC
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1701
Mailing Address - Country:US
Mailing Address - Phone:203-336-4000
Mailing Address - Fax:203-382-2954
Practice Address - Street 1:46 ALBION ST
Practice Address - Street 2:SOUTHWEST COMMUNITY HEALTH CENTER, INC
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2602
Practice Address - Country:US
Practice Address - Phone:203-332-3155
Practice Address - Fax:203-330-6008
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2014-08-08
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Provider Licenses
StateLicense IDTaxonomies
CT52219207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236130Medicaid