| NAME |
NEW LONDON |
| STATE |
CONNECTICUT |
| STREET ADDR. 1 |
6 SHAWS CV STE 104 |
| CITY |
NEW LONDON |
| ZIP |
06320-4969 |
| OFFICIAL VA NAME |
NEW LONDON |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
NEW LONDON VA CLINIC |
| ST. ADDR. 1 (MAILING) |
4 SHAW'S COVE, SUITE 101 |
| CITY (MAILING) |
NEW LONDON |
| STATE (MAILING) |
CONNECTICUT |
| ZIP (MAILING) |
06320-8100 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1942247820
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
689HC |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1942247820
-
- CODING SYSTEM: VASTANUM
- ID: 689HC
-
- CODING SYSTEM: CLIA
- ID: 07D1010393
|
