Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 10304 | CT |
Y | 213EG0000X | General Practice | 10304 | CT |
NPI | 1003123605 |
---|---|
Provider Name | Dr. Alesia Nicola Burge |
First Address | Hamden, CT 06514-2406 |
Second Address | Hamden, CT 06514-2406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2010 |
Last Update Date | 25/10/2012 |