Organization
WALLINGFORD MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUANITA H DEE APRN (OWNER)
(860) 798-2614
Entity
Organization
Contact information
Practice address
850 N MAIN STREET EXT UNIT 1D2, WALLINGFORD, CT 06492-2400
(860) 798-2614
(860) 467-4612
Mailing address
150 EPISCOPAL RD, BERLIN, CT 06037-1525
(860) 798-2614
(860) 467-4612
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609344480
—
CT
05
—
1669889820
—
CT
Enumeration date
02/03/2022
Last updated
02/17/2022
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