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Organization

BUCKLAND EAR NOSE & THROAT LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. BETSY GRAVES (OFFICE MANAGER)
(860) 645-6675
Entity
Organization

Contact information

Practice address
360 TOLLAND TPKE, SUITER 1E, MANCHESTER, CT 06042-1771
(860) 645-6675
Mailing address
360 TOLLAND TPKE, SUITE 1E, MANCHESTER, CT 06042-1771
(860) 645-6675
(860) 645-8677

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
021430
CT
235500000X
Speech/Language/Hearing Specialist/Technologist
000196
CT
332B00000X
Durable Medical Equipment & Medical Supplies

Other

Enumeration date
07/27/2007
Last updated
12/29/2015
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