Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 048179 | CT |
NPI | 1023057114 |
---|---|
Provider Name | Marco Petrazzuoli |
First Address | Milford, CT 06460-3537 |
Second Address | Milford, CT 06460-3537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 07/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G85551 | (02) | CT |