Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 619412 | CT |
NPI | 1053574533 |
---|---|
Provider Name | Dr. Colleen Mary Pietras |
First Address | New Haven, CT 06510 |
Second Address | New Haven, CT 06510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2008 |
Last Update Date | 01/10/2018 |