DR. GENEVIEVE MONTAGU VON WALSTROM (NPI# 1962797696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962797696 |
| Entity Type | Individual |
| Full Name | DR. GENEVIEVE MONTAGU VON WALSTROM |
| Credential | MD |
| Practice Address |
17 Wall St Madison CT 06443-3122 |
| Mailing Address |
2310 Bigelow Cmns Enfield CT 06082-3342 |
| Practice Telephone | 2037795126 |
| Practice Fax Number | 2032450572 |
| Mailing Telephone | 2035548803 |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2020-02-04 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
57243 | CT | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 57243 | CT | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 57243 | CT | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3 Electronics Ave Ste 201, Danvers, MA 019231099 | 9787500300 | 9782791324 |
| 506 6th St, Brooklyn, NY 112153609 | 7187803272 |
| Street Address |
17 WALL ST |
| City | MADISON |
| State | CT |
| Zip Code | 06443-3122 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700804044 | Kathy Bryson | Nurse Practitioner | 17 Wall St, Madison, CT 06443-3122 | 2006-07-17 |
| 1851767933 | Waterstone Counseling Center, LLC | Psychologist | 17 Wall St, Madison, CT 06443-3122 | 2015-08-12 |
| 1861610479 | Judith M Jorgensen | Counselor | 17 Wall St, Madison, CT 06443-3122 | 2007-04-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194127506 | Heather R. Clinton | Social Worker | 847 West Main Street, Suite 3, Branford, CT 06443 | 2014-09-17 |
| 1477973378 | Katrina Louise Furey | Psychiatry & Neurology | 147 Durham Rd Ste 12a-ne, Madison, CT 06443 | 2014-04-18 |
| 1972920114 | Elizabeth Laberee | Internal Medicine | 80 Devonshire Lane, Madison, CT 06443 | 2014-03-26 |
| 1588007314 | Avery Grauer | Psychiatry & Neurology | 175 Copse Road, Madison, CT 06443 | 2013-04-11 |
| 1295077790 | Gordon Seth Cohen | Pathology | 3 Silo Hill Road, Madison, CT 06443 | 2013-03-22 |
| 1073750493 | Darlene F. Talavera | Occupational Therapist | 22 Overshore Drive, Madison, CT 06443 | 2009-01-08 |
| 1013182518 | Susan Jean Isaac | Social Worker | 105 Winding Road, Unit 2, Madison, CT 06443 | 2008-04-25 |
| 1083893606 | Kornelia Keszler, Md, PC | Internal Medicine | 1-b Meigswood Ave, Madison, CT 06443 | 2007-10-31 |
| 1811181126 | Traci Marando | Nurse Practitioner | 20 Madrina Lane, Madison, CT 06443 | 2007-08-29 |
| 1790803419 | Linda L. Young | Social Worker | 2 Samson Rock Drive, Unit 2g, Madison, CT 06443 | 2007-03-27 |
| Find all providers in zip 06443 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760946628 | Amie Jabang | General Practice | 534 Aztalan Dr, Madison, WI 53718-3205 | 2019-01-24 |
| 1255693347 | Robin Louise Chene | General Practice | 530 W Lakeside St, Madison, WI 53715-1728 | 2012-06-13 |
| 1780941740 | Nemil Ashvin Shah | General Practice | 101 Ivory Pl, Madison, AL 35758-2349 | 2012-04-16 |
| 1780951095 | Erwin Fredrick Koenig I | General Practice | 825 Charing Cross Rd, Madison, WI 53704-6082 | 2011-11-30 |
| 1942517164 | Anne Elizabeth Bauer | General Practice | 102 Big Oak Cir, Madison, AL 35758-8324 | 2010-09-09 |
| 1710207923 | Fredrick Howard Bronson | General Practice | 13 Cherokee Cir, 102, Madison, WI 53704-8480 | 2010-06-10 |
| 1043351182 | Richard Lee Owens | General Practice | 1920 Monroe St, Madison, WI 53711-2027 | 2007-02-10 |
| 1184630592 | American Family Care Inc | General Practice | 7559 Hwy 72 W, Madison, AL 35758 | 2006-07-31 |
| 1174543516 | Karen B Duffy | General Practice | 1210 Briarville Road, Blding B, Madison, TN 37115 | 2006-07-20 |
| 1558318832 | Sriramloo Kesari | General Practice | 173 State St, Madison, WV 25130 | 2006-05-30 |
| Find all providers in MADISON | ||||
Please comment or provide details below to improve the information on DR. GENEVIEVE MONTAGU VON WALSTROM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.