Provider Demographics
NPI:1770867525
Name:WINDHAM RHEUMATOLOGY, LLC
Entity Type:Organization
Organization Name:WINDHAM RHEUMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IOANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:STANESCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-456-6105
Mailing Address - Street 1:10 HIGGINS HWY
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1437
Mailing Address - Country:US
Mailing Address - Phone:860-456-6105
Mailing Address - Fax:
Practice Address - Street 1:10 HIGGINS HWY
Practice Address - Street 2:SUITE 14
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:860-456-6105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT36670207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1780625418OtherINDIVIDUAL NPI