Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 048571 | CT |
NPI | 1033300728 |
---|---|
Provider Name | Dr. Maria Elena Johnson |
First Address | Hartford, CT 06106-5501 |
Second Address | Hartford, CT 06106-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 01/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008040276 | (05) | CT |