Provider Demographics
NPI:1760599518
Name:WILTON MEDICAL WALK IN CLINIC INC
Entity Type:Organization
Organization Name:WILTON MEDICAL WALK IN CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT WILTON MEDICAL WALK IN CL
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-834-8885
Mailing Address - Street 1:35 DANBURY RD
Mailing Address - Street 2:UNIT 5 WILTON MEDICAL WALK-IN CLINIC INC
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897
Mailing Address - Country:US
Mailing Address - Phone:203-834-8885
Mailing Address - Fax:203-834-8889
Practice Address - Street 1:35 DANBURY RD
Practice Address - Street 2:UNIT 5 WILTON MEDICAL WALK-IN CLINIC INC
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897
Practice Address - Country:US
Practice Address - Phone:203-834-8885
Practice Address - Fax:203-834-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000272207R00000X
CT015149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02476OtherPTAN NUMBER
040000272CT01OtherBCBS
2V6049OtherHEALTH NET
010015149CT02OtherBCBS
OV4868OtherHEALTH NET
C02476OtherPTAN NUMBER
C01824Medicare UPIN
2V6049OtherHEALTH NET
C02476Medicare UPIN