Windham Primary Care LLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

037518 Issued in CT

Legal business name

WINDHAM PRIMARY CARE LLC

Practice address

387 Tuckie Rd Ste C
North Windham, CT 06256-1355

Phone

(860) 456-1279

Fax

(860) 456-1298

NPI assigned

Jul 26, 2007

Last updated

Jul 26, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Obinna I Maduka, MDNPI 1710065917

Title

Owner

Phone

(860) 456-1279

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Obinna I Maduka, MD

  • Pediatrics Physician
  • North Windham, CT
  • NPI 1710065917
  NPD (past) Authorized official

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185408000000",
    "number": "1780874776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 TUCKIE RD STE C",
            "city": "NORTH WINDHAM",
            "state": "CT",
            "postal_code": "062561355",
            "telephone_number": "860-456-1279",
            "fax_number": "860-456-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 TUCKIE RD STE C",
            "city": "NORTH WINDHAM",
            "state": "CT",
            "postal_code": "062561355",
            "telephone_number": "860-456-1279",
            "fax_number": "860-456-1298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINDHAM PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2007-07-26",
        "status": "A",
        "authorized_official_last_name": "MADUKA",
        "authorized_official_first_name": "OBINNA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-456-1279",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CT",
            "license": "037518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michaela Suchomel
• Total Renal Care Inc (Windham Dialysis Center)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2022)
• Wal-Mart Stores East, LP (Vision Center 30-2022)
• Windham Community Memorial Hospital
• Mary Boss Withey, APRN

• Pediatric Adolescent Medicine Physician in North Windham, CT
• Providers in North Windham, CT by specialty
• Pediatric Adolescent Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; 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.