Provider Demographics
NPI:1770567190
Name:ROCHESTER, CAROLYN L (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
Last Name:ROCHESTER
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:789 HOWARD AVE
Mailing Address - Street 2:FITKIN BUILDING, 2ND FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1304
Mailing Address - Country:US
Mailing Address - Phone:203-785-4198
Mailing Address - Fax:203-785-3826
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:FITKIN BUILDING, 2ND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-785-4198
Practice Address - Fax:203-785-3826
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT029485207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001294850Medicaid
CT110004185Medicare ID - Type Unspecified
CT001294850Medicaid