Individual
DR. DANA WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
40 MANSFIELD AVE, WILLIMANTIC, CT 06226-2018
(860) 450-7471
(860) 450-0213
Mailing address
40 MANSFIELD AVE, WILLIMANTIC, CT 06226-2018
(860) 450-7471
(860) 450-0213
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29768
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01002768CT06
ANTHEM BLUE CROSS & BLUE
CT
01
—
722627
CONNECTICARE ID
CT
01
—
HAP281
OXFORD ID
CT
Enumeration date
06/14/2006
Last updated
03/07/2023
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