Provider Demographics
NPI:1205894607
Name:HSU, FLORENCE IDA (MD)
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:IDA
Last Name:HSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 CEDAR ST
Mailing Address - Street 2:PO BOX 208013
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8013
Mailing Address - Country:US
Mailing Address - Phone:203-785-4170
Mailing Address - Fax:203-785-3229
Practice Address - Street 1:6 DEVINE ST STE 2B
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2222
Practice Address - Country:US
Practice Address - Phone:203-287-6200
Practice Address - Fax:203-287-6101
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT49738207K00000X, 207RA0201X
MA217989207K00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2119242Medicaid
MA2119242Medicaid