# WINDHAM UROLOGY GROUP, PC

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

## Provider details

- **NPI number:** 1407126782
- **Authorized official:** JOHN N GRAHAM MD (PARTNER)
- **Authorized official phone:** (860) 928-0819

## Contact information

- **Practice address:** 24 WINDHAM ST, WILLIMANTIC, CT 06226-2216
- **Practice address phone:** (860) 423-5656
- **Practice address fax:** (860) 423-2122
- **Mailing address:** 24 WINDHAM ST, WILLIMANTIC, CT 06226-2216
- **Mailing address phone:** (860) 426-5656
- **Mailing address fax:** (860) 423-2122

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/04/2012
- **Last updated:** 01/04/2012