MEDICARE: ROSE KNITTEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ML60661994	WA
2	207QA0505X	Adult Medicine Physician	MD60876085	WA
3	207Q00000X	Family Medicine Physician	MD60876085	WA
4	207Q00000X	Family Medicine Physician	75693	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01414618	OTHER	WA	LABOR AND INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942657671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE KNITTEL M.D.

Provider Business Mailing Address
First Line	:	1290 SILAS DEANE HIGHWAY
Second Line	:	HHC - CVO
City	:	WETHERSFIELD
State	:	CT
Zip	:	06109-4337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 CAPITOL AVE
Second Line	:	PO BOX 150469-1172
City	:	HARTFORD
State	:	CT
Zip	:	06106-1659
Country	:	US
Telephone Number	:	860-380-5150
Fax Number	:	860-726-2230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	05/10/2024

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Directions to “ ROSE KNITTEL M.D.” Practice Location

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