Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 033025 | CT |
NPI | 1033160924 |
---|---|
Provider Name | Ms. Grace L Federman |
First Address | Danbury, CT 06811 |
Second Address | Danbury, CT 06811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 21/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1330258 | (05) | CT |
E30580 | (02) |