Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 035123 | CT |
NPI | 1063438463 |
---|---|
Provider Name | Mrs. Tanya S Futoryan |
First Address | Westport, CT 06880-4435 |
Second Address | Westport, CT 06880-4435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 27/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G25671 | (02) | CT |