Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 016089 | CT |
NPI | 1124396767 |
---|---|
Provider Name | Dr. Lynn Walton Whelchel JR. |
First Address | Colebrook, CT 06021-7093 |
Second Address | Colebrook, CT 06021-7093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2011 |
Last Update Date | 11/12/2011 |