Organization
ANNETTE L HEADLEY MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNETTE L HEADLEY MD (PROPRIETOR/PHYSICIAN)
(860) 536-1354
Entity
Organization
Contact information
Practice address
56 WHITEHALL AVE, MYSTIC, CT 06355-1978
(860) 536-1354
(860) 536-7043
Mailing address
56 WHITEHALL AVE, MYSTIC, CT 06355-1978
(860) 536-1354
(860) 536-7043
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
034245
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295841682
PERSONAL NPI NUMBER
CT
Enumeration date
10/15/2010
Last updated
11/09/2010
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