Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 031204 | CT |
NPI | 1184643439 |
---|---|
Provider Name | John H Senechal |
First Address | Tolland, CT 06084-3915 |
Second Address | Tolland, CT 06084-3915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 21/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001312040 | (05) | CT |