Provider Demographics
NPI:1477539922
Name:EROR, ELLYSSA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLYSSA
Middle Name:L
Last Name:EROR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1025 SILAS DEANE HWY
Mailing Address - Street 2:HARTFORD MEDICAL GROUP
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4229
Mailing Address - Country:US
Mailing Address - Phone:860-696-2400
Mailing Address - Fax:860-696-2410
Practice Address - Street 1:1025 SILAS DEANE HWY
Practice Address - Street 2:HARTFORD MEDICAL GROUP
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4229
Practice Address - Country:US
Practice Address - Phone:860-696-2400
Practice Address - Fax:860-696-2410
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2010-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT043298207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1477539922OtherNPI
CT001432989Medicaid
CT1477539922OtherNPI
CT001432989Medicaid
P00293578Medicare PIN