Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 025220 | CT |
NPI | 1083720908 |
---|---|
Provider Name | Marian Kellner |
First Address | West Hartford, CT 06117-2515 |
Second Address | West Hartford, CT 06117-2515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 31/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001252204 | (05) | CT |
B39606 | (02) |