Provider Demographics
NPI:1942657671
Name:KNITTEL, ROSE K (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:K
Last Name:KNITTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1290 SILAS DEANE HIGHWAY
Mailing Address - Street 2:HHC - CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 SEABURY DR FL 5
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-5618
Practice Address - Country:US
Practice Address - Phone:860-380-5150
Practice Address - Fax:860-726-2230
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60661994207Q00000X
WAMD60876085207Q00000X, 207QA0505X
CT75693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2059441Medicaid
WA01414618OtherLABOR AND INDUSTRIES