# COASTAL DIGESTIVE DISEASES PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053441147
- **Authorized official:** DR. GEORGE S OUELLETTE M.D. (PRESIDENT)
- **Authorized official phone:** (860) 442-0290

## Contact information

- **Practice address:** 234 BANK ST, 4TH FLOOR, NEW LONDON, CT 06320-6070
- **Practice address phone:** (860) 442-0290
- **Practice address fax:** (860) 442-2136
- **Mailing address:** 234A BANK ST, 4TH FLOOR, NEW LONDON, CT 06320-6054
- **Mailing address phone:** (860) 442-0290
- **Mailing address fax:** (860) 442-2136

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | 3032224000 | CT | Yes |
| 207RG0100X | Gastroenterology Physician | 3032224000 | CT | — |

## Other

- **Enumeration date:** 03/07/2007
- **Last updated:** 12/07/2011