Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 8878 | CT |
NPI | 1073726030 |
---|---|
Provider Name | Marius Alexandru Marinescu |
First Address | Madison, CT 06443-3476 |
Second Address | Madison, CT 06443-3476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |