Healthcare Provider Details

I. General information

NPI: 1700247897
Provider Name (Legal Business Name): DR. MARIE A. DI PASQUALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 LINCOLN AVENUE
PALO ALTO CA
94301
US

IV. Provider business mailing address

705 LINCOLN AVENUE
PALO ALTO CA
94301
US

V. Phone/Fax

Practice location:
  • Phone: 203-216-5421
  • Fax:
Mailing address:
  • Phone: 203-216-5421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number016555
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: