1891047049 NPI number — ASHLEY CORINNE NOTARTOMASO M.D.

Table of content: ASHLEY CORINNE NOTARTOMASO M.D. (NPI 1891047049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891047049 NPI number — ASHLEY CORINNE NOTARTOMASO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOTARTOMASO
Provider First Name:
ASHLEY
Provider Middle Name:
CORINNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROGERS
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
CORINNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891047049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
282 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06106-3322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-837-5560
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
282 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-837-5560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0204X , with the licence number:  63693 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)