Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 38225 | CT |
N | 207RP1001X | Pulmonary Disease | 038225 | CT |
NPI | 1023125549 |
---|---|
Provider Name | Robert J Mcdonald |
First Address | Waterbury, CT 06708 |
Second Address | Waterbury, CT 06708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 13/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1382259 | (05) | CT |
G08650 | (02) |