Individual
ELIZABETH MAE ROESSLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
374 GRAND AVE, NEW HAVEN, CT 06513-3733
(203) 777-7411
(203) 401-2042
Mailing address
PO BOX 208237, 55 LOCK ST, NEW HAVEN, CT 05511
(203) 432-0076
(203) 432-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000673
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0V8014
HEALTHNET
CT
01
—
290000673CT03
ANTHEM BCBS
CT
01
—
673000I420
CONNECTICARE
CT
01
—
970025160
RAILROAD MEDICARE
CT
01
—
P2685637
OXFORD
CT
Enumeration date
11/08/2005
Last updated
07/24/2013
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