Organization
MWL-WALLINGFORD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRANAV SHAH (OWNERE)
(203) 446-4555
Entity
Organization
Contact information
Practice address
1243 S BROAD ST, WALLINGFORD, CT 06492-1737
(203) 446-4555
Mailing address
1243 S BROAD ST, WALLINGFORD, CT 06492-1737
(203) 446-4555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/21/2020
Last updated
08/02/2022
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