Individual
PETR PROTIVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
950 CAMPBELL AVE, DEPARTMENT OF MEDICINE, BLD 1, 5TH FLOOR, WEST HAVEN, CT 06516-2770
(203) 932-5711
Mailing address
950 CAMPBELL AVE, DEPARTMENT OF MEDICINE, BLD 1, 5TH FLOOR, WEST HAVEN, CT 06516-2770
(203) 932-5711
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
044277
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1442772
—
CT
Enumeration date
06/18/2006
Last updated
06/12/2013
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