Provider Demographics
NPI:1760450886
Name:JOSLIN, E SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:E SPENCER
Middle Name:
Last Name:JOSLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 RIVER ROAD
Mailing Address - Street 2:P.O. BOX 2797
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2797
Mailing Address - Country:US
Mailing Address - Phone:860-704-4045
Mailing Address - Fax:860-704-4301
Practice Address - Street 1:915 RIVER RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3921
Practice Address - Country:US
Practice Address - Phone:860-704-4045
Practice Address - Fax:860-704-4301
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037683207QA0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01376830Medicaid
G88262Medicare UPIN