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Individual

ROSS G UTTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
134 GRANDVIEW AVE, WATERBURY, CT 06708-2507
(203) 756-8911
(203) 574-0548
Mailing address
134 GRANDVIEW AVE, WATERBURY, CT 06708
(203) 756-8911
(203) 574-0548

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001124
CT
363AS0400X
Surgical Physician Assistant
001124
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
290001124CT02
ANTHEM
01
51124
AIM
01
711609
CTCARE
01
A437740
OXFORD
01
OR0365
AETNA HEALTHNET
Enumeration date
04/28/2006
Last updated
01/30/2008
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