Sally Rosengren, MD
Individual provider Active NPI Clinical Genetics (M.D.) Physician · West Hartford, CT
NPI 1912904335 · NPPES record last updated Aug 7, 2013
Key facts
- NPI
- 1912904335
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Genetics (M.D.) Physician 207SG0201X
- License
- 025891 (CT)
- Practice address
- 65 Kane St
Genetics
West Hartford, CT 06119-2110 - Phone
- (860) 523-6464
- Fax
- (860) 523-6465
- NPI assigned
- Jun 30, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025891 | CT | MD | Clinical Genetics (M.D.) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Connecticut Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Genetics (M.D.) Physician | 207SG0201X | 025891 | CT | Yes |
| Pediatrics Physician | 208000000X | 025891 | CT |
Addresses
Primary practice location
65 Kane St
Genetics
West Hartford, CT 06119-2110
Mailing address
263 Farmington Ave
Provider Enrollment
Farmington, CT 06030-2212
Phone (860) 679-7503
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1258912 | Medicaid | CT |
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All providers in West Hartford, CT · Clinical Genetics (M.D.) Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.