Cornelius W. Wickersham, M.D.

Internal Medicine Physician · Waterbury, CT

Individual Active NPI

NPI number 1104893650

Practice location

49 Leavenworth St
Suite 200
Waterbury, CT 06702-2115
Phone
(602) 317-6874
Fax
(602) 953-7767

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NPI record

NPI
1104893650
Entity type
Individual (Type 1)
Enumeration date
March 3, 2006
Last updated
October 19, 2007
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Internal Medicine Physician Primary 207R00000X 013709 CT

Mailing address

11811 N Tatum Blvd
Suite 3031
Phoenix, AZ 85028-1614
Phone
(602) 317-6874
Fax
(602) 953-7767

About Dr. Wickersham

Cornelius W. Wickersham, M.D. is a healthcare provider registered in the NPI registry with the primary taxonomy Internal Medicine Physician (code 207R00000X). The practice location is 49 Leavenworth St, Suite 200, Waterbury, CT 06702-2115. The NPI number 1104893650 was assigned on March 3, 2006 and the record was last updated on October 19, 2007.

Dr. Wickersham lists a license in the registry: #013709 (CT) for Internal Medicine Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Cornelius W. Wickersham, M.D.?

The NPI number is 1104893650.

What is the phone number of Dr. Wickersham?

The phone number listed for the practice location is (602) 317-6874.

Where is Dr. Wickersham located?

49 Leavenworth St, Suite 200, Waterbury, CT 06702-2115.

What is the taxonomy code for Dr. Wickersham?

The primary taxonomy code is 207R00000X – Internal Medicine Physician.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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