Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 032289 | CT |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 32289 | CT |
NPI | 1205834363 |
---|---|
Provider Name | Raul Mendelovici |
First Address | Hartford, CT 06105-1770 |
Second Address | Bloomfield, CT 06002-3088 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001322891 | (05) | CT |
F80072 | (02) | CT |