Provider Demographics
NPI:1053448589
Name:KOORN, ALLA ROMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:ROMAN
Last Name:KOORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2216
Mailing Address - Country:US
Mailing Address - Phone:203-348-2614
Mailing Address - Fax:206-325-8677
Practice Address - Street 1:30 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3628
Practice Address - Country:US
Practice Address - Phone:203-276-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041678207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001416785Medicaid
CTH80298Medicare UPIN
CT050001476Medicare ID - Type Unspecified