Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 028608 | CT |
N | 2080P0208X | Pediatric Infectious Diseases | 028608 | CT |
NPI | 1427389808 |
---|---|
Provider Name | Richard Bertram Wilber |
First Address | Cheshire, CT 06410-1746 |
Second Address | Cheshire, CT 06410-1746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2010 |
Last Update Date | 25/01/2010 |