Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 041509 | CT |
NPI | 1225035322 |
---|---|
Provider Name | Pietro A Memmo |
First Address | Farmington, CT 06032-2565 |
Second Address | Hartford, CT 06106-5521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 28/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001415092 | (05) | CT |
H85438 | (02) | CT |