Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 030452 | CT |
N | 208000000X | Pediatrician | 030452 | CT |
NPI | 1558367698 |
---|---|
Provider Name | Romana Primus |
First Address | Waterford, CT 06385-4112 |
Second Address | New London, CT 06320-4902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 19/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E06636 | (02) |