Healthcare Provider Details

I. General information

NPI: 1982949285
Provider Name (Legal Business Name): RTR PEDIATRICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 WEST ST UNIT 7
DANBURY CT
06810-6525
US

IV. Provider business mailing address

93 WEST ST UNIT 7
DANBURY CT
06810-6525
US

V. Phone/Fax

Practice location:
  • Phone: 203-628-7891
  • Fax: 203-628-7893
Mailing address:
  • Phone: 203-628-7891
  • Fax: 203-628-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number043478
License Number StateCT

VIII. Authorized Official

Name: PAMELA A. PAULHUS
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 203-628-7891