Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 11006 | CT |
Y | 213EG0000X | General Practice | 11006 | CT |
NPI | 1003170374 |
---|---|
Provider Name | Dr. Kaitlin Mary Peretto |
First Address | Collinsville, CT 06019-3425 |
Second Address | East Windsor, CT 06088-9502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2012 |
Last Update Date | 21/08/2014 |