Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 020052 | CT |
NPI | 1134122104 |
---|---|
Provider Name | Richard Edwards |
First Address | Hartford, CT 06105-1719 |
Second Address | Hartford, CT 06105-1217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 14/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001200526 | (05) | CT |
E61144 | (02) | CT |