Organization
SOUTHEASTERN PULMONARY ASSOC. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN S URBANETTI MD (CEO)
(860) 444-2223
Entity
Organization
Contact information
Practice address
155 MONTAUK AVENUE, NEW LONDON, CT 06320
(860) 444-2223
(860) 440-3153
Mailing address
155 MONTAUK AVENUE, NEW LONDON, CT 06320
(860) 444-2223
(860) 440-3153
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
022011
CT
207RP1001X
Pulmonary Disease Physician
022057
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022057
LIC DR ROBERT KELTNER
CT
05
—
1220110
—
CT
05
—
1220573
—
CT
Enumeration date
07/19/2006
Last updated
01/20/2016
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