Organization
COASTAL DIGESTIVE DISEASES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE S OUELLETTE M.D. (PRESIDENT)
(860) 442-0290
Entity
Organization
Contact information
Practice address
234 BANK ST, 4TH FLOOR, NEW LONDON, CT 06320-6070
(860) 442-0290
(860) 442-2136
Mailing address
234A BANK ST, 4TH FLOOR, NEW LONDON, CT 06320-6054
(860) 442-0290
(860) 442-2136
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
3032224000
CT
207RG0100X
Gastroenterology Physician
3032224000
CT
Other
Enumeration date
03/07/2007
Last updated
12/07/2011
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