Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 049671 | CT |
N | 207PP0204X | Pediatric Emergency Physician | 242282 | NY |
NPI | 1083876874 |
---|---|
Provider Name | Dr. Vincent Matt Laurich |
First Address | Hartford, CT 06106-3322 |
Second Address | Hartford, CT 06106-3322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 26/05/2015 |