Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 029101 | CT |
NPI | 1093795940 |
---|---|
Provider Name | Daniel M Rose |
First Address | Shelton, CT 06484 |
Second Address | Bridgeport, CT 06606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1291012 | (05) | CT |
A64074 | (02) |