Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 031302 | CT |
NPI | 1003927047 |
---|---|
Provider Name | Dr. Sonia Gordon-Dole |
First Address | Haddam, CT 06438-1346 |
Second Address | Hamden, CT 06518-3508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 28/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E76715 | (02) |