Charles Walcott (NPI# 1790043446, PAC ID# 5092946764) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1790043446 |
| PAC ID by PECOS | 5092946764 |
| Professional Enrollment ID | I20150923000372 |
| Full Name | Charles Walcott |
| Organization Legal Name | NORTHEAST MEDICAL GROUP INC |
| Address |
248 Flanders Rd Niantic CT 06357-1264 |
| Phone Number | 8607395426 |
| Gender | M |
| Medical School | LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE |
| Graduation Year | 2012 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 1254233836 |
| Number of Group Practice Members | 1014 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 070007 | LAWRENCE & MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 248 Flanders Rd, Niantic, CT 06357-1264 | 8607395426 | NORTHEAST MEDICAL GROUP INC |
| Organization Legal Name | NORTHEAST MEDICAL GROUP INC |
| Physicians | 1113 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Daniel J Razzano | Internal Medicine | Northeast Medical Group Inc | 1 Long Wharf Dr, New Haven, CT 06511-5991 |
| Irene Besser | Certified Nurse Midwife (cnm) | Northeast Medical Group Inc | 3 Shaws Cv, New London, CT 06320-4952 |
| Ang Zhang | Internal Medicine | Northeast Medical Group Inc | 50 Gaylord Farm Rd, Wallingford, CT 06492-2828 |
| Carolyn Brown | Nurse Practitioner | Northeast Medical Group Inc | 112 Quarry Rd, Suite 400, Trumbull, CT 06611-4877 |
| Nicole Parry | Nurse Practitioner | Northeast Medical Group Inc | 999 Silver Lane, Trumbull, CT 06611-5343 |
| Amanda L Hall | Nurse Practitioner | Northeast Medical Group Inc | 1308 Chapel St, New Haven, CT 06511-4515 |
| Murielle Exantus | Nurse Practitioner | Northeast Medical Group Inc | 422 Highland Ave, Cheshire, CT 06410-2526 |
| Brittany L Provenzano | Nurse Practitioner | Northeast Medical Group Inc | 887 Bridgeport Ave, Shelton, CT 06484-7602 |
| Pradnya Velankar | Cardiovascular Disease (cardiology) | Northeast Medical Group Inc | 230 Waterford Pkwy S, Waterford, CT 06385-1219 |
| Kitima Boonvisudhi | General Surgery | Northeast Medical Group Inc | 40 Boston Post Rd, Waterford, CT 06385-2424 |
| Street Address |
248 FLANDERS RD |
| City | NIANTIC |
| State | CT |
| Zip | 06357-1264 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jitesh Vachhani | Internal Medicine | Northeast Medical Group Inc | 248 Flanders Rd, Niantic, CT 06357-1264 |
| Erica L Lussier | Nurse Practitioner | Northeast Medical Group Inc | 248 Flanders Rd, Niantic, CT 06357-1264 |
| Brian L Williams | Family Medicine | Northeast Medical Group Inc | 248 Flanders Rd, Niantic, CT 06357-1264 |
| Steven Jack | Clinical Social Worker | Northeast Medical Group Inc | 248 Flanders Rd, Niantic, CT 06357-1264 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jill Richmond-covey | Clinical Social Worker | Richmond Covey, Inc. | 206 Roxbury Rd, Niantic, CT 06357-1011 |
| Robert L Covey | Clinical Social Worker | Richmond Covey, Inc. | 206 Roxbury Rd, Niantic, CT 06357-1011 |
| Rosalinda G Gaona | Internal Medicine | 10 Liberty Way, B10, Niantic, CT 06357-1033 | |
| Josee Cloutier | Family Medicine | 10 Liberty Way, Unit B10, Niantic, CT 06357-1033 | |
| Craig E Mcknight | Obstetrics/gynecology | 10 Liberty Way, Unit B10, Niantic, CT 06357-1033 | |
| Tianne A Pape | Chiropractic | Pape Chiropractic and Wellness Center LLC | 11 Freedom Way, Unit B 01, Niantic, CT 06357-1041 |
| Renee A Brown | Chiropractic | Pape Chiropractic and Wellness Center LLC | 11 Freedom Way, Unit B 01, Niantic, CT 06357-1041 |
| Ryan Vannieuwenhuyze | Physical Therapy | 11 Freedom Way, Unit B2, Niantic, CT 06357-1041 | |
| Corey Podbielski | Physical Therapy | Spectrum Physical Therapy Limited Partnership | 11 Freedom Way, Unit B2, Niantic, CT 06357-1041 |
| Ryne Mcmullen | Physical Therapy | Spectrum Physical Therapy Limited Partnership | 11 Freedom Way, Unit B2, Niantic, CT 06357-1041 |
| Find all physicians in zip 06357 | |||
| City | NIANTIC |
| Zip Code | 06357 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | NIANTIC + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Charles Walcott.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.