Individual
DR. NAHEED ASAD VAN DE WALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 SALEM TPKE, NORWICH, CT 06360-7403
(860) 972-5107
Mailing address
111 SALEM TPKE, NORWICH, CT 06360-7403
(860) 972-5107
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
154841
NY
208100000X
Physical Medicine & Rehabilitation Physician
Primary
64242
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0037004
GHI
NY
05
—
00790496
—
NY
01
—
230152
WCB
NY
01
—
55247
HIP
NY
01
—
A300100661
PTAN
NY
01
—
P2728904
OXFORD
NY
Enumeration date
02/23/2007
Last updated
02/03/2022
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