Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 023964 | CT |
NPI | 1053318386 |
---|---|
Provider Name | Ann L Parke |
First Address | Hartford, CT 06105-1719 |
Second Address | Hartford, CT 06105-1770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 03/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1239649 | (05) | CT |
E73172 | (02) | CT |