Provider Demographics
NPI:1255560124
Name:ROESCH, ELEONORE (MD)
Entity type:Individual
Prefix:
First Name:ELEONORE
Middle Name:
Last Name:ROESCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 MAIN AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1080
Mailing Address - Country:US
Mailing Address - Phone:860-621-6704
Mailing Address - Fax:860-621-0446
Practice Address - Street 1:98 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2500
Practice Address - Country:US
Practice Address - Phone:860-621-6704
Practice Address - Fax:860-621-0446
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT052102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine