Provider Demographics
NPI:1952320475
Name:RISING, JOSHUA PEDER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:PEDER
Last Name:RISING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 ORANGE ST # 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3824
Mailing Address - Country:US
Mailing Address - Phone:203-535-9983
Mailing Address - Fax:
Practice Address - Street 1:637 ORANGE ST # 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3824
Practice Address - Country:US
Practice Address - Phone:203-535-9983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046018208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics