Healthcare Provider Details

I. General information

NPI: 1730387499
Provider Name (Legal Business Name): TRISHA LYN PESCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISHA LYN CHUCK

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 HAYNES ST MANCHESTER MEMORIAL HOSPITAL
MANCHESTER CT
06040-4131
US

IV. Provider business mailing address

71 HAYNES ST MANCHESTER MEMORIAL HOSPITAL
MANCHESTER CT
06040-4131
US

V. Phone/Fax

Practice location:
  • Phone: 860-647-6827
  • Fax: 860-533-3452
Mailing address:
  • Phone: 860-647-6827
  • Fax: 860-533-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number050536
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number8276
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: