Graduated: 1991
NPI: 1164495875
Practice Locations (2)
PROSPECT CT MEDICAL FOUNDATION INC
140 GRANDVIEW AVE, SUITE L01
WATERBURY, CT 067082500
2035744187
TRINITY HEALTH OF NEW ENGLAND PROVIDER NETWORK ORGANIZATION INC
56 FRANKLIN ST
WATERBURY, CT 067061253
2037096000
Source: CMS National Downloadable File, September 2026.