Individual
SUSAN WISKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
675 TOWER AVE, HARTFORD, CT 06112-1260
(860) 714-2913
(860) 714-8988
Mailing address
675 TOWER AVE, HARTFORD, CT 06112-1260
(860) 714-2913
(860) 714-8988
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
027125
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001271253
—
CT
01
—
010027125CT01
ANTHEM BLUE SHIELD
CT
01
—
0V4805
HEALTHNET
—
Enumeration date
07/24/2006
Last updated
06/21/2021
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