=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033104245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN KUROWSKI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2005
-----------------------------------------------------
Last Update Date | 10/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 SHAWS COVE, SUITE 201
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-440-3070
-----------------------------------------------------
Fax | 860-444-7692
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 SHAWS COVE, SUITE 201
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-440-3070
-----------------------------------------------------
Fax | 860-444-7692
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 033630
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | BK4017744
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------