Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 033522 | CT |
NPI | 1316924749 |
---|---|
Provider Name | Doron J Ber |
First Address | Mystic, CT 06355-1959 |
Second Address | Mystic, CT 06355-1959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 27/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F75168 | (02) |