Provider Demographics
NPI:1043484264
Name:DERMESROPIAN, RACHA (MD)
Entity type:Individual
Prefix:
First Name:RACHA
Middle Name:
Last Name:DERMESROPIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHA
Other - Middle Name:
Other - Last Name:ABBOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1208
Mailing Address - Country:US
Mailing Address - Phone:860-714-4402
Mailing Address - Fax:860-714-8086
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-4402
Practice Address - Fax:860-714-8086
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051406207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism