Individual
MARSHALL P GRODOFSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
836 FARMINGTON AVENUE, SUITE 207, WEST HARTFORD, CT 06119
(860) 232-9911
(860) 233-5996
Mailing address
836 FARMINGTON AVENUE, SUITE 207, WEST HARTFORD, CT 06119
(860) 232-9911
(860) 233-5996
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
027137
CT
207KA0200X
Allergy Physician
Primary
027137
CT
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
027137
CT
2080P0201X
Pediatric Allergy/Immunology Physician
27137
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001271378
—
CT
05
—
00127137800
—
CT
01
—
010027137CT01
BLUE CROSS
—
01
—
020138
CONNECTICARE
—
01
—
0585739002
CIGNA
—
01
—
216970
PREFERRED ONE
—
05
—
OS2228
—
CT
01
—
P1870457
OXFORD
—
Enumeration date
11/09/2005
Last updated
08/25/2015
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