=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477793529
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRINA G ROSEWATER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2009
-----------------------------------------------------
Last Update Date | 11/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 ORCHARD ST STE 207
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511-3206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-776-4444
-----------------------------------------------------
Fax | 203-776-4441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 ORCHARD ST STE 207
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511-5363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-776-4444
-----------------------------------------------------
Fax | 203-776-4441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 044226
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------