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General NPI Number Information
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NPI Number | 1083691794
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Entity Type | Individual
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Provider Name | CAROL PETRUFF MD
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Gender | Female
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 44 DALE RD PRIME HEALTHCARE
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City | AVON
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State | CT
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Zip | 06001-3612
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Country | US
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Telephone | 860-674-8830
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Fax | 860-674-8984
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Provider Business Mailing Address
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Address Line | 30 JORDAN LN PRIME HEALTHCARE
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City | WETHERSFIELD
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State | CT
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Zip | 06109-1278
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Country | US
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Telephone | 860-263-0253
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Fax | 860-263-0262
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 033353
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License Number State | CT
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