Individual
BOONSRI KOSARUSSAVADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20 YORK ST, YALE NEW HAVEN HOSPITAL, NEW HAVEN, CT 06510-3220
(203) 785-2802
(203) 785-6664
Mailing address
300 GEORGE ST, 6TH FLOOR PO BOX 9805, NEW HAVEN, CT 06511-6624
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
016869
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001168699
—
CT
Enumeration date
11/17/2005
Last updated
08/04/2008
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