Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 037545 | CT |
NPI | 1003892829 |
---|---|
Provider Name | Marlene Schwartz |
First Address | Willimantic, CT 06226-2045 |
Second Address | Willimantic, CT 06226-2045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 17/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003892829 | NPI (01) | CT |
F87318 | (02) | CT |