Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 026125 | CT |
NPI | 1023011145 |
---|---|
Provider Name | Michael Therrien |
First Address | Hartford, CT 06105-1719 |
Second Address | Hartford, CT 06105-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B83653 | (02) | CT |