Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 011104 | CT |
NPI | 1891792529 |
---|---|
Provider Name | Dr. George A Sprecace |
First Address | Waterford, CT 06385-1234 |
Second Address | New London, CT 06320-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 26/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B38411 | (02) | CT |