Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 040326 | CT |
NPI | 1144374067 |
---|---|
Provider Name | Dr. Brian Bernard Malone |
First Address | North Haven, CT 06473-2124 |
Second Address | Torrington, CT 06790-6679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |