Provider Demographics
NPI:1013916097
Name:SAWICKI, EDWARD STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:STANLEY
Last Name:SAWICKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HHC CVO ENROLLMENT
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-6970
Mailing Address - Fax:
Practice Address - Street 1:1703 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1162
Practice Address - Country:US
Practice Address - Phone:860-456-1781
Practice Address - Fax:860-450-1660
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT1163922207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT16392OtherCT LICENSE
B83847Medicare UPIN