Provider Demographics
NPI:1932596087
Name:WIDDICOMBE, ABBOTT COTTON (MD)
Entity Type:Individual
Prefix:
First Name:ABBOTT
Middle Name:COTTON
Last Name:WIDDICOMBE
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 1:464 CONGRESS AVE
Mailing Address - Street 2:SUITE 260, DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1361
Mailing Address - Country:US
Mailing Address - Phone:203-785-5174
Mailing Address - Fax:
Practice Address - Street 1:464 CONGRESS AVE
Practice Address - Street 2:SUITE 260, DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1361
Practice Address - Country:US
Practice Address - Phone:203-785-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT60330207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program