Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 001122 | CT |
NPI | 1154926855 |
---|---|
Provider Name | Sean P Mcgee |
First Address | Woodbury, CT 06798-3007 |
Second Address | Woodbury, CT 06798-3007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2020 |
Last Update Date | 01/12/2020 |