Individual
JOHN M WILLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 LONG WHARF DR, SUITE 302, NEW HAVEN, CT 06511-5991
(203) 624-2689
(203) 776-7741
Mailing address
1 LONG WHARF DR, SUITE 302, NEW HAVEN, CT 06511-5991
(203) 624-2689
(203) 776-7741
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
031736
CT
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
031736
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001317363
—
CT
01
—
040004571
RAILROAD MEDICARE PIN
CT
Enumeration date
07/28/2006
Last updated
07/02/2009
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