Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 032872 | CT |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 032872 | CT |
N | 2086S0105X | Surgery of the Hand | 032872 | CT |
NPI | 1710931738 |
---|---|
Provider Name | Douglas C Wisch |
First Address | Torrington, CT 06790 |
Second Address | Torrington, CT 06790 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 17/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001328724 | (05) | CT |
010032872CT01 | BC (01) | CT |
2205151 | AETNA (01) | CT |
F01248 | (02) |