Provider Demographics
NPI:1750459483
Name:CHARTER OAK WALK IN MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:CHARTER OAK WALK IN MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-739-6953
Mailing Address - Street 1:324 FLANDERS RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1735
Mailing Address - Country:US
Mailing Address - Phone:860-739-6953
Mailing Address - Fax:860-739-2523
Practice Address - Street 1:324 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1735
Practice Address - Country:US
Practice Address - Phone:860-739-6953
Practice Address - Fax:860-739-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0829260001Medicare NSC