Provider Demographics
NPI:1891970331
Name:PODIATRY ASSOCIATES OF WATERBURY PC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF WATERBURY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-754-4247
Mailing Address - Street 1:PO BOX 2657
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-2657
Mailing Address - Country:US
Mailing Address - Phone:203-206-9700
Mailing Address - Fax:
Practice Address - Street 1:80 PHOENIX AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1418
Practice Address - Country:US
Practice Address - Phone:203-754-4247
Practice Address - Fax:203-757-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000227213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OV7691OtherHEALTHNET
706363OtherCONNECTICARE
NHS333OtherOXFORD HEALTH PLANS
355659OtherWELLCARE
CT4086022Medicaid
0051391OtherAETNA
030000227CT01OtherANTHEM BLUE CROSS
706363OtherCONNECTICARE
CT4086022Medicaid