Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 041496 | CT |
NPI | 1013939214 |
---|---|
Provider Name | Prashant Grover |
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 | 24/07/2006 |
Last Update Date | 15/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I10646 | (02) | CT |