Individual
DR. EDWARD JOHN DETWEILER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
114 WOODLAND ST, HARTFORD, CT 06105-1208
(860) 714-4000
Mailing address
71 HAYNES ST, MANCHESTER, CT 06040-4131
(860) 533-4679
(860) 645-4151
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
66853
CT
207R00000X
Internal Medicine Physician
66853
CT
Other
Enumeration date
04/24/2018
Last updated
04/28/2023
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