Healthcare Provider Details

I. General information

NPI: 1417367012
Provider Name (Legal Business Name): AUBRI MAGNIFICO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 TRIANGLE ST
DANBURY CT
06810
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE DHMC
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 203-448-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number60049
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: