Healthcare Provider Details

I. General information

NPI: 1720309206
Provider Name (Legal Business Name): VERONICA MARIA PIMENTEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND STREET MATERNAL/FETAL MEDICINE
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

1300 HALL BLVD 3RD FL - POD B - ENROLLMENTS/CREDENTIALING
BLOOMFIELD CT
06002-2918
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4378
  • Fax:
Mailing address:
  • Phone: 860-714-9333
  • Fax: 860-714-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number244314
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: