Healthcare Provider Details

I. General information

NPI: 1720068679
Provider Name (Legal Business Name): RAFAEL P SQUITIERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN STREET
BRIDGEPORT CT
06606
US

IV. Provider business mailing address

1177 SUMMER ST
STAMFORD CT
06905-5572
US

V. Phone/Fax

Practice location:
  • Phone: 203-576-5708
  • Fax: 203-367-8392
Mailing address:
  • Phone: 203-576-5708
  • Fax: 203-367-8392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number039409
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number039409
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: