Provider Demographics
NPI:1952344004
Name:NEW LONDON CANCER CENTER, P.C
Entity Type:Organization
Organization Name:NEW LONDON CANCER CENTER, P.C
Other - Org Name:NEW LONDON CANCER CENTER, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITHLESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-443-4455
Mailing Address - Street 1:196 PARKWAY S
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1234
Mailing Address - Country:US
Mailing Address - Phone:860-442-7027
Mailing Address - Fax:860-444-0074
Practice Address - Street 1:196 PARKWAY S
Practice Address - Street 2:SUITE 303
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1219
Practice Address - Country:US
Practice Address - Phone:860-443-4455
Practice Address - Fax:860-447-8961
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LONDON CANCER CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-14
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X
CT332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4646870001Medicare NSC