Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 033909 | CT |
NPI | 1245376771 |
---|---|
Provider Name | Anna George |
First Address | Hartford, CT 06120-2508 |
Second Address | Hartford, CT 06120-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 18/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001339094 | (05) | CT |
00517R | (02) | CT |