Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 034314 | CT |
N | 207YP0228X | Pediatric Otolaryngology | 034314 | CT |
NPI | 1144230749 |
---|---|
Provider Name | Mark A Dagostino |
First Address | New Haven, CT 06511-5991 |
Second Address | New Haven, CT 06511-5991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 02/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001343144 | (05) | CT |
040011092 | RAILROAD MEDICARE PIN (01) | CT |
G41465 | (02) |