Organization
CRESCENT ST OBGYN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIE S FLAGG MD (OWNER)
(860) 344-9993
Entity
Organization
Contact information
Practice address
49 CRESCENT ST, MIDDLETOWN, CT 06457-3601
(860) 344-9993
Mailing address
49 CRESCENT ST, MIDDLETOWN, CT 06457-3601
(860) 344-9993
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
002684
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236924
—
CT
Enumeration date
06/11/2008
Last updated
06/11/2008
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