Provider Information for 1083612477
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JULIAN FORD PhD
Sex: Male
NPI: 1083612477
Last Updated: 2022-07-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
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| NPI | 1083612477 | ||||||||||||||||
| Enumeration Date | 2005-07-11 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 263 FARMINGTON AVE PROVIDER ENROLLMENT FARMINGTON, CT 06030-2212 United States Phone: 860-679-7503 | Fax:860-679-1610 | ||||||||||||||||
| Primary Practice Address | 10 TALCOTT NOTCH RD FARMINGTON, CT 06032-1800 United States Phone: 860-679-6700 | Fax:860-679-6736 | ||||||||||||||||
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