Individual
HEIDI BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 688-4242
Mailing address
333 CEDAR STREET, TMP3, NEW HAVEN, CT 06510
(203) 688-4242
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
FB4291782
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2020
Last updated
08/06/2024
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