Healthcare Provider Details

I. General information

NPI: 1184691800
Provider Name (Legal Business Name): DANILO MANALESE PANGILINAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WOODLAND ST
HARTFORD CT
06105-4318
US

IV. Provider business mailing address

21 WOODLAND ST
HARTFORD CT
06105-4318
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-6745
  • Fax: 860-293-2021
Mailing address:
  • Phone: 860-527-6745
  • Fax: 860-293-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number031988
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number031988
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: