Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 010787 | CT |
NPI | 1285789081 |
---|---|
Provider Name | Dr. William Mancoll |
First Address | West Hartford, CT 06107-1116 |
Second Address | West Hartford, CT 06107-1116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B39431 | (02) | CT |