Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 048604 | CT |
N | 207Q00000X | Family Doctor | MD432931 | PA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 048604 | CT |
NPI | 1124291448 |
---|---|
Provider Name | Ross H Albert |
First Address | Hartford, CT 06102-5037 |
Second Address | Hartford, CT 06102-5037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 19/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008016993 | (05) | CT |
048604 | CT LICENSE (01) | CT |