Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 000558 | CT |
NPI | 1104813955 |
---|---|
Provider Name | Marissa Girolamo |
First Address | Stamford, CT 06905-5510 |
Second Address | Stamford, CT 06905-5510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 07/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022112 | HEALTHNET (01) | CT |
030000558CT01 | BLUE CROSS (01) | CT |
0328216002 | CIGNA (01) | CT |
19858 | (02) | CT |
480000468 | MEDICARE ID# (01) | CT |
95809 | AETNA HEALTH PLAN (01) | CT |