Provider Demographics
NPI:1871785766
Name:THAMES GYNECOLOGIC GROUP PC
Entity type:Organization
Organization Name:THAMES GYNECOLOGIC GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:AMDUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-442-0383
Mailing Address - Street 1:425 MONTAUK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4642
Mailing Address - Country:US
Mailing Address - Phone:860-442-0383
Mailing Address - Fax:860-442-7266
Practice Address - Street 1:425 MONTAUK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4642
Practice Address - Country:US
Practice Address - Phone:860-442-0383
Practice Address - Fax:860-442-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02495Medicare PIN