Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0900X | Dermatopathologist | 047989 | CT |
NPI | 1558403311 |
---|---|
Provider Name | Soheil S Dadras |
First Address | Farmington, CT 06030-2212 |
Second Address | Farmington, CT 06032-2482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 14/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1558403311 | (05) | CT |