Healthcare Provider Details

I. General information

NPI: 1780681353
Provider Name (Legal Business Name): REBECCA PRINGLE MD, PH. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA BOGY MD

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S MAIN ST
CHESHIRE CT
06410-3153
US

IV. Provider business mailing address

675 S MAIN ST
CHESHIRE CT
06410-3153
US

V. Phone/Fax

Practice location:
  • Phone: 203-272-1811
  • Fax: 203-271-3152
Mailing address:
  • Phone: 203-250-2125
  • Fax: 203-250-2162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number038516
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: