Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 017267 | CT |
N | 207ND0900X | Dermatopathologist | 017267 | CT |
N | 207NP0225X | Pediatric Dermatologist | 017267 | CT |
N | 207NS0135X | Procedural Dermatology | 017267 | CT |
NPI | 1578560132 |
---|---|
Provider Name | Ellen Block Milstone |
First Address | Hamden, CT 06518-3248 |
Second Address | Hamden, CT 06518-3248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010017267CT03 | ANTHEM BLUE CROSS (01) | CT |
750372 | CONNECTICARE (01) | CT |
D82911 | (02) | CT |