Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 034694 | CT |
NPI | 1073690848 |
---|---|
Provider Name | Frank R. Dellacono |
First Address | Stonington, CT 06378-2209 |
Second Address | Waterford, CT 06385-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G05867 | (02) | CT |