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General NPI Number Information
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NPI Number | 1306080767
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Entity Type | Organization
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Legal Business Name | CHRISTINE E. DESMOND,MD,LLC
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 240 BRADLEY ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-1108
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Country | US
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Telephone | 203-773-9220
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Fax |
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Provider Business Mailing Address
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Address Line | 240 BRADLEY ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-1108
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Country | US
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Telephone | 203-773-9220
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHRISTINE E. DESMOND
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Credential | MD
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Telephone | 203-773-9220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 040365
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License Number State | CT
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