Provider Demographics
NPI:1720071681
Name:WINAKOR, ROSS L (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:L
Last Name:WINAKOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PROFESSIONAL PARK RD.
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268
Mailing Address - Country:US
Mailing Address - Phone:860-487-0002
Mailing Address - Fax:860-429-1663
Practice Address - Street 1:34 PROFESSIONAL PARK RD.
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268
Practice Address - Country:US
Practice Address - Phone:860-487-0002
Practice Address - Fax:860-429-1663
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92328Medicare UPIN