Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 028882 | CT |
NPI | 1003867649 |
---|---|
Provider Name | Phillip Dennen |
First Address | Hartford, CT 06105-1208 |
Second Address | Hartford, CT 06105-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 12/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001266825 | (05) | CT |
B83296 | (02) | CT |