Individual
PAGE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
219 KENT RD, NEW MILFORD, CT 06776-5528
(860) 355-6949
Mailing address
219 KENT RD, NEW MILFORD, CT 06776-5528
(860) 355-6949
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000492
CT
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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