Healthcare Provider Details

I. General information

NPI: 1801391891
Provider Name (Legal Business Name): ANNA MEOLA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E GRANBY RD
GRANBY CT
06035-2201
US

IV. Provider business mailing address

71 HAYNES ST
MANCHESTER CT
06040-4131
US

V. Phone/Fax

Practice location:
  • Phone: 860-653-7261
  • Fax:
Mailing address:
  • Phone: 860-533-4679
  • Fax: 860-645-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number68804
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: