Healthcare Provider Details

I. General information

NPI: 1447253422
Provider Name (Legal Business Name): SUSAN RABINOWE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 WOODLAND ST
HARTFORD CT
06105-1217
US

IV. Provider business mailing address

1000 ASYLUM AVE STE 2109A
HARTFORD CT
06105-1719
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4680
  • Fax: 860-714-8047
Mailing address:
  • Phone: 860-714-6581
  • Fax: 860-714-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number033127
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: