Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 018012 | CT |
N | 111NI0900X | Internist | 018012 | CT |
Y | 207RH0002X | Hospice and Palliative Medicine | 018012 | CT |
NPI | 1033103130 |
---|---|
Provider Name | Alison Lane-Reticker |
First Address | Boston, MA 02241-5933 |
Second Address | Hartford, CT 06102-5037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 04/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001180124 | (05) | CT |
1033103130 | (05) | CT |
E80496 | (02) |