Healthcare Provider Details

I. General information

NPI: 1164630406
Provider Name (Legal Business Name): ELLEN F FOXMAN M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 N MAIN ST
WEST HARTFORD CT
06117-2055
US

IV. Provider business mailing address

1047 N MAIN ST
WEST HARTFORD CT
06117-2055
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-2244
  • Fax:
Mailing address:
  • Phone: 860-236-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number050191
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: