Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 052903 | CT |
N | 207PP0204X | Pediatric Emergency Physician | 52903 | CT |
NPI | 1790002848 |
---|---|
Provider Name | Avital Porat |
First Address | Hartford, CT 06102-5037 |
Second Address | Hartford, CT 06102-5037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 29/07/2016 |