Organization
WATERBURY ORTHOPAEDIC ASSOCIATES P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC JON OLSON M.D. (PRESIDENT)
(203) 755-0163
Entity
Organization
Contact information
Practice address
1211 W MAIN ST, WATERBURY, CT 06708-3106
(203) 755-0163
(203) 574-5894
Mailing address
1211 W MAIN ST, WATERBURY, CT 06708-3106
(203) 755-0163
(203) 574-5894
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
CT
335E00000X
Prosthetic/Orthotic Supplier
—
CT
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004394110
—
CT
Enumeration date
11/10/2006
Last updated
08/02/2012
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