Individual
JILL BIANCA WATRAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
34 MAPLE ST, NORWALK, CT 06850-3894
(703) 867-6793
Mailing address
34 MAPLE ST, NORWALK, CT 06850-3894
(703) 867-6793
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301095745
MI
2086S0102X
Surgical Critical Care Physician
0101257513
VA
2086S0102X
Surgical Critical Care Physician
72602
CT
2086S0127X
Trauma Surgery Physician
Primary
72602
CT
Other
Enumeration date
05/15/2007
Last updated
10/12/2022
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