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Esravila Ariya Wibisono, MD
Student in an Organized Health Care Education/Training Program in Waterbury, Connecticut
NPI 1972233708

Esravila Ariya Wibisono is a Student in an Organized Health Care Education/Training Program based in Waterbury, CT. Esravila Ariya Wibisono practices in Waterbury, CT and has the professional credentials of MD. The NPI Number for Esravila Ariya Wibisono is 1972233708 and holds a License No. (Connecticut).

The current practice location address for Esravila Ariya Wibisono is 56 Franklin St Ste 1, Waterbury, CT and can be reached out via phone at 203-709-8685 and via fax at 203-709-3518.

Location: 56 Franklin St Ste 1, Waterbury, CT, 06706-1281
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1972233708
Provider Name
Esravila Ariya Wibisono
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
56 Franklin St Ste 1, Waterbury, CT, 06706-1281
Phone Number
203-709-8685
Fax Number
203-709-3518
Provider Enumeration Date
06/14/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
56 Franklin St Ste 1
City
Waterbury
State
Connecticut
Zip
06706-1281
Phone Number
203-709-8685
Fax Number
203-709-3518
person
Provider Business Mailing Address Details
Address
56 Franklin St Ste 1
City
Waterbury
State
Connecticut
Zip
06706-1281
Phone Number
203-709-8685
Fax Number
203-709-3518
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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