Individual
OTTILIE T ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
78 PERSHING DR, DERBY, CT 06418-1433
(203) 709-8873
(203) 709-8689
Mailing address
78 PERSHING DR, DERBY, CT 06418-1433
(203) 709-8873
(203) 709-8689
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
030635
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001306358
—
CT
Enumeration date
07/24/2006
Last updated
06/01/2022
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