Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 024790 | CT |
NPI | 1053396275 |
---|---|
Provider Name | Peter R Rogol |
First Address | New Haven, CT 06510-2716 |
Second Address | New Haven, CT 06510-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 23/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1247907 | (05) | CT |
D85293 | (02) |