Provider Demographics
NPI:1750488870
Name:KNOWLES, SALLY ELIZABETH (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ELIZABETH
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 MIGEON AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-4643
Mailing Address - Country:US
Mailing Address - Phone:860-387-0439
Mailing Address - Fax:860-482-3067
Practice Address - Street 1:469 MIGEON AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-4643
Practice Address - Country:US
Practice Address - Phone:860-387-0439
Practice Address - Fax:860-482-3067
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64833207R00000X
CT52504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA17609Medicare UPIN