Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 037672 | CT |
N | 2080A0000X | Adolescent Medicine | 037672 | CT |
NPI | 1275697310 |
---|---|
Provider Name | Michelle C Caserta |
First Address | North Haven, CT 06473-3019 |
Second Address | North Haven, CT 06473-3019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001376723 | (05) | CT |