Individual
INA LICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
80 SEYMOUR ST, HARTFORD, CT 06102-8000
(860) 972-2085
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-8082
(860) 679-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
077532
CT
208M00000X
Hospitalist Physician
Primary
077532
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/17/2021
Last updated
10/07/2024
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