Individual
KAREN M. PRESTWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22 MASONIC AVE, 1ST FLOOR, WALLINGFORD, CT 06492-3095
(203) 679-5900
(203) 679-6873
Mailing address
22 MASONIC AVE, 1ST FLOOR, WALLINGFORD, CT 06492-3095
(203) 679-5900
(203) 679-6873
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
029068
CT
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
029068
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D400000928
MEDICARE PTAN
CT
Enumeration date
12/26/2006
Last updated
02/02/2010
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