Provider Demographics
NPI:1780775080
Name:KOORSE, ROBERT EDWARD (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWARD
Last Name:KOORSE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:136 WEST MAIN STREET
Mailing Address - Street 2:HARTFORD ORTHOPEDIC MEDICINE
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1315
Mailing Address - Country:US
Mailing Address - Phone:860-826-4763
Mailing Address - Fax:860-826-4762
Practice Address - Street 1:100 WELLS STREET- SUITE 1B
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103
Practice Address - Country:US
Practice Address - Phone:860-525-2672
Practice Address - Fax:860-727-0897
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2016-05-04
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Provider Licenses
StateLicense IDTaxonomies
CT032768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1073711651Medicaid
CT1073711651Medicaid