Healthcare Provider Details

I. General information

NPI: 1528404373
Provider Name (Legal Business Name): JOSEPH DANIEL FUSCO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST DEPARTMENT OF MEDICINE
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

114 WOODLAND ST
HARTFORD CT
06105-1208
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-7446
  • Fax: 860-714-1508
Mailing address:
  • Phone: 860-714-7446
  • Fax: 860-714-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number55065
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: