1184688376 NPI number — DR. ROBERT SATTERLEE WETMORE M.D.

Table of content: MARGARET LEE CLARKE M.A. CCC-A (NPI 1851621098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184688376 NPI number — DR. ROBERT SATTERLEE WETMORE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WETMORE
Provider First Name:
ROBERT
Provider Middle Name:
SATTERLEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184688376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1579 STRAITS TPKE
Provider Second Line Business Mailing Address:
STE E1
Provider Business Mailing Address City Name:
MIDDLEBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06762-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-758-1760
Provider Business Mailing Address Fax Number:
203-758-8838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 SCOVILL ST STE 308
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06706-1127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-709-6680
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  023619 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 23619 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03-69411 . This is a "AMERICHOICE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010023619CT04 . This is a "ANTHEM BCBS CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V7019 . This is a "HEALTHNET/COMMERCIAL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3715679 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "RR MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1066903 . This is a "USA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1427808/4226785 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 419532 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 03-69411 . This is a "UHC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001236199 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023619 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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