Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 026503 | CT |
NPI | 1023014289 |
---|---|
Provider Name | Carl D Malchoff |
First Address | Farmington, CT 06030-2212 |
Second Address | Farmington, CT 06030-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 02/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1265032 | (05) | CT |
E37118 | (02) | CT |