Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 027169 | CT |
Y | 208600000X | Surgeon | 027169 | CT |
NPI | 1003903956 |
---|---|
Provider Name | Dr. Sara Ann Case |
First Address | Bantam, CT 06750-1315 |
Second Address | Bantam, CT 06750-1315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 27/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001271691 | (05) | CT |
1003903956 | (05) | CT |
1003903956 | NPI NUMBER (01) | |
D02803 | (02) | |
P00759522 | MEDICARE RAILROAD (01) | CT |