Healthcare Provider Details

I. General information

NPI: 1770567190
Provider Name (Legal Business Name): CAROLYN L ROCHESTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 HOWARD AVE FITKIN BUILDING, 2ND FLOOR
NEW HAVEN CT
06519-1304
US

IV. Provider business mailing address

789 HOWARD AVE FITKIN BUILDING, 2ND FLOOR
NEW HAVEN CT
06519-1304
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4198
  • Fax: 203-785-3826
Mailing address:
  • Phone: 203-785-4198
  • Fax: 203-785-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number029485
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number029485
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: