Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 1.069278 | CT |
NPI | 1295026037 |
---|---|
Provider Name | Ansley Morgan Roche |
First Address | New Haven, CT 06520-8041 |
Second Address | New Haven, CT 06519-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2011 |
Last Update Date | 20/09/2021 |