Individual
SUSAN ANN HERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-4477
(860) 679-4474
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-4477
(860) 679-4474
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
046120
CT
207R00000X
Internal Medicine Physician
Primary
225459-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649263880
NPI, NORWALK HOSPITAL
CT
Enumeration date
01/07/2008
Last updated
03/25/2015
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