Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 032335 | CT |
NPI | 1003886185 |
---|---|
Provider Name | Dr. Marc Andre Paradis |
First Address | East Hartford, CT 06108-3212 |
Second Address | East Hartford, CT 06108-3212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 17/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001323352 | (05) | CT |
F36507 | (02) |