Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 19383 | CT |
NPI | 1013060599 |
---|---|
Provider Name | Richard S. Childs II |
First Address | Hartford, CT 06150-0774 |
Second Address | Torrington, CT 06790-6679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 07/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
702346 | CONNECTICARE (01) | |
E35687 | (02) |