Healthcare Provider Details

I. General information

NPI: 1700060068
Provider Name (Legal Business Name): ELIZABETH JANE NORTHROP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 SAYBROOK RD SUITE 100
MIDDLETOWN CT
06457-4711
US

IV. Provider business mailing address

4 FARM SPRINGS RD
FARMINGTON CT
06032-2573
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6683
  • Fax: 860-343-5957
Mailing address:
  • Phone: 860-284-5200
  • Fax: 860-284-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47563
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: