Mark Brown

Individual provider Active NPI Hearing Instrument Specialist · Willimantic, CT

NPI 1831570746 · NPPES record last updated Jun 16, 2015

Key facts

NPI
1831570746
Entity type
Individual (NPI type 1)
Primary specialty
Hearing Instrument Specialist 237700000X
License
392 (CT)
Practice address
95 Storrs Rd
Willimantic, CT 06226-4012
Phone
(860) 423-7807
Fax
(860) 423-7393
NPI assigned
Jun 16, 2015
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
392CTMDHearing Instrument Specialist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing Instrument Specialist 237700000X 392 CT Yes

Addresses

Primary practice location

95 Storrs Rd
Willimantic, CT 06226-4012

Mailing address

126 Gardner Ave
New London, CT 06320-4348
Phone (860) 938-1118

Other identifiers

IdentifierTypeStateIssuer
1598891855MedicaidCT

Other providers in Willimantic, CT

All providers in Willimantic, CT · Hearing Instrument Specialist in Connecticut

Sources for this page

Verify at the official NPI Registry.