Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 045754 | CT |
NPI | 1043409691 |
---|---|
Provider Name | Michael Cohenuram |
First Address | Danbury, CT 06810-6099 |
Second Address | Danbury, CT 06810-6099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2007 |
Last Update Date | 19/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045754 | MEDICAL LICENSE (01) | CT |