MEDICARE: DONNA R CRISCENZO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	022662	CT

General Provider Information

NPI Number	:	1225036528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA R CRISCENZO M.D.

Provider Business Mailing Address
First Line	:	199 GOOSE LANE
Second Line	:
City	:	GUILFORD
State	:	CT
Zip	:	06437-2115
Country	:	US
Telephone Number	:	203-458-2888
Fax Number	:	203-458-2889

Provider Business Practice Location Address
First Line	:	199 GOOSE LANE
Second Line	:
City	:	GUILFORD
State	:	CT
Zip	:	06437-2115
Country	:	US
Telephone Number	:	203-458-2888
Fax Number	:	203-458-2889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	05/13/2009

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