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Individual

DR. IVELISSE AUBIN VIRUET

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
153 MAIN ST, MANCHESTER, CT 06042-3112
(860) 432-5803
Mailing address
153 MAIN ST, MANCHESTER, CT 06042-3112
(860) 432-5803

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
034410
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001344100
CT
01
010034410CT01
BC/BS
CT
01
034410
MEDICAL LICENSE
CT
Enumeration date
12/23/2005
Last updated
03/07/2023
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