Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 028952 | CT |
NPI | 1043235567 |
---|---|
Provider Name | Dr. Richard Roger Viscarello JR. |
First Address | Stamford, CT 06905-5315 |
Second Address | Stamford, CT 06905-5315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 24/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E84435 | (02) |