Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 03901 | CT |
NPI | 1053311662 |
---|---|
Provider Name | Sina Raissi |
First Address | Middlebury, CT 06762-2843 |
Second Address | Middlebury, CT 06762-2843 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 06/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001390111 | (05) | CT |
H46452 | (02) |