Greater Waterbury Primary Care Assoc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GREATER WATERBURY PRIMARY CARE ASSOC

Practice address

166 Waterbury Road
Ste 300
Prospect, CT 06712

Phone

(203) 758-0878

Fax

(203) 758-0877

NPI assigned

May 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dennis C King, MD

Title

Secretary

Phone

(203) 758-0878

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033167804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 WATERBURY ROAD",
            "address_2": "STE 300",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "06712",
            "telephone_number": "203-758-0878",
            "fax_number": "203-758-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 WATERBURY ROAD",
            "address_2": "STE 300",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "06712",
            "telephone_number": "203-758-0878",
            "fax_number": "203-758-0877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER WATERBURY PRIMARY CARE ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "203-758-0878",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurene M. Gomez, L.M.F.T.
• Tonya Goodman, APRN-PMHNP
• Daniel Griswold Gordon, LMFT
• Alexa Gorman
• Lisa Grabowski, BS
• Greater Waterbury Retina, LLC
• Deborah Grove, LMFT
• Robert Steven Guynn, RPH
• George J Hajjar, LCSW
• Gary Arthur Higgins, LCSW

• All providers in Prospect, CT
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.