Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 027137 | CT |
Y | 207KA0200X | Allergist | 027137 | CT |
N | 2080P0201X | Pediatric Allergist | 27137 | CT |
NPI | 1841271699 |
---|---|
Provider Name | Marshall P Grodofsky |
First Address | West Hartford, CT 06119 |
Second Address | West Hartford, CT 06119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 25/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001271378 | (05) | CT |
00127137800 | (05) | CT |
010027137CT01 | BLUE CROSS (01) | |
020138 | CONNECTICARE (01) | |
0585739002 | CIGNA (01) | |
216970 | PREFERRED ONE (01) | |
B84461 | (02) | |
OS2228 | (05) | CT |
P1870457 | OXFORD (01) |