Provider Demographics
NPI:1073711651
Name:ROBERT E. KOORSE MD LLC
Entity type:Organization
Organization Name:ROBERT E. KOORSE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOORSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-524-5083
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 4303
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-524-5083
Mailing Address - Fax:860-524-5085
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 4303
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-524-5083
Practice Address - Fax:860-524-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03736Medicare PIN