Healthcare Provider Details

I. General information

NPI: 1487945051
Provider Name (Legal Business Name): VICTORIA MATILDA GROSSI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST MEDICAL EDUCATION, 4 H
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST MEDICAL EDUCATION, 4H
HARTFORD CT
06106
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9973
  • Fax:
Mailing address:
  • Phone: 860-545-9973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number54511
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: