Healthcare Provider Details

I. General information

NPI: 1922001940
Provider Name (Legal Business Name): THOMAS TERENZI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE STE 2112
HARTFORD CT
06105-1719
US

IV. Provider business mailing address

1000 ASYLUM AVE STE 2109A
HARTFORD CT
06105-1719
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4749
  • Fax: 860-714-8439
Mailing address:
  • Phone: 860-714-6581
  • Fax: 860-714-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number041490
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: