Basic Information
| Provider Information | |||||||||
| NPI: | 1558367698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRIMUS | ||||||||
| FirstName: | ROMANA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 TWIN LAKES DR | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063854112 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 SHAWS CV | ||||||||
| Address2: | |||||||||
| City: | NEW LONDON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063204902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604478304 | ||||||||
| FaxNumber: | 8604438720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 03/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | 030452 | CT | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | 208000000X | 030452 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.