Healthcare Provider Details

I. General information

NPI: 1588732473
Provider Name (Legal Business Name): JOSEPH A COATTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SAYBROOK RD SUITE 110
MIDDLETOWN CT
06457
US

IV. Provider business mailing address

400 SAYBROOK RD SUITE 110
MIDDLETOWN CT
06457
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-9167
  • Fax: 860-347-1630
Mailing address:
  • Phone: 860-347-9167
  • Fax: 860-347-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number028448
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: