Healthcare Provider Details

I. General information

NPI: 1013943190
Provider Name (Legal Business Name): JOHN P IANNARONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MAIN ST
BRIDGEPORT CT
06606-1839
US

IV. Provider business mailing address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

V. Phone/Fax

Practice location:
  • Phone: 203-371-4445
  • Fax:
Mailing address:
  • Phone: 203-576-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025630
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: