Healthcare Provider Details

I. General information

NPI: 1497664270
Provider Name (Legal Business Name): CORINNE MICHELLE O'TOOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 LEWIS AVE
MERIDEN CT
06451-2101
US

IV. Provider business mailing address

35 CHESTNUT CT
CROMWELL CT
06416-1781
US

V. Phone/Fax

Practice location:
  • Phone: 203-694-5701
  • Fax:
Mailing address:
  • Phone: 860-759-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number158057
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: