Provider Demographics
NPI:1780726026
Name:THE WOMEN'S CENTER OF SOUTHERN NEW ENGLAND, LLC
Entity type:Organization
Organization Name:THE WOMEN'S CENTER OF SOUTHERN NEW ENGLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-269-0885
Mailing Address - Street 1:850 N MAIN STREET EXT
Mailing Address - Street 2:BLDG 1, UNIT 1C
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2400
Mailing Address - Country:US
Mailing Address - Phone:203-269-0885
Mailing Address - Fax:203-269-3496
Practice Address - Street 1:850 N MAIN STREET EXT
Practice Address - Street 2:BLDG 1, UNIT 1C
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2400
Practice Address - Country:US
Practice Address - Phone:203-269-0885
Practice Address - Fax:203-269-3496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037129207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG74432Medicare UPIN