Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 036939 | CT |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 9535 | ND |
NPI | 1154323426 |
---|---|
Provider Name | Rohini Ruth Becherl |
First Address | Hartford, CT 06151-0634 |
Second Address | Hartford, CT 06102-5037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 18/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001369396 | (05) | CT |
12940 | (05) | ND |
23723 | BLUE CROSS BLUE SHIELD ND (01) | ND |
G85247 | (02) | ND |