Provider Demographics
NPI:1013969419
Name:NEW LONDON FAMILY PRACTICE,LLC
Entity Type:Organization
Organization Name:NEW LONDON FAMILY PRACTICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-929-4357
Mailing Address - Street 1:187 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-1018
Mailing Address - Country:US
Mailing Address - Phone:419-929-4357
Mailing Address - Fax:419-929-0814
Practice Address - Street 1:187 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-1018
Practice Address - Country:US
Practice Address - Phone:419-929-4357
Practice Address - Fax:419-929-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9301571Medicare PIN