Individual
SUZANNE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
263 FARMINGTON AVE, GASTROENTEROLOGY, FARMINGTON, CT 06030-2817
(860) 679-3238
(860) 679-1217
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT OFFICE, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
050382
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144258930
—
CT
Enumeration date
06/29/2006
Last updated
06/19/2012
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