Basic Information
| Provider Information | |||||||||
| NPI: | 1326376633 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT S THORSEN MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 N MAIN ST | ||||||||
| Address2: | SUITE 3C | ||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064892537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606211896 | ||||||||
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| Practice Location | |||||||||
| Address1: | 51 N MAIN ST | ||||||||
| Address2: | SUITE 3C | ||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064892537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606211896 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2009 | ||||||||
| LastUpdateDate: | 11/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | THORSEN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8606211896 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 028680 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.