Individual
JOHN WENCESLAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 COTTAGE GROVE RD STE D110, BLOOMFIELD, CT 06002-3085
(860) 530-2014
Mailing address
1000 ASYLUM AVE, SUITE 3218, HARTFORD, CT 06105-1770
(860) 714-5415
(860) 714-8861
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
035462
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010035462CT01
ANTHEM BLUE SHIELD
CT
05
—
01354620
—
CT
01
—
0V4804
HEALTHNET
—
Enumeration date
07/26/2006
Last updated
06/21/2021
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