Individual
RICHARD JAY WILCON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
122 PLAINFIELD RD, MOOSUP, CT 06354-1632
(860) 564-4062
(860) 564-4879
Mailing address
122 PLAINFIELD RD, MOOSUP, CT 06354-1632
(860) 564-4062
(860) 564-4879
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
032260
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001322601
—
CT
01
—
010032260CT01
ANTHEM BC/BS
—
01
—
01032260
CIGNA HEALTH PLANS
—
01
—
030486
HEALTH NET
—
01
—
110093870
RAILROAD MEDICARE
—
01
—
705139
CONNECTICARE
—
01
—
P367719
OXFORD HEALTH PLANS
—
Enumeration date
07/26/2006
Last updated
10/26/2007
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