Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 044646 | CT |
Y | 208600000X | Surgeon | 044646 | CT |
N | 2086S0127X | Trauma Surgeon | 044646 | CT |
NPI | 1245342575 |
---|---|
Provider Name | Alisa Savetamal |
First Address | Bridgeport, CT 06610-0246 |
Second Address | Bridgeport, CT 06610-2811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 14/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
044646 | MEDICAL LICENSE (01) | CT |