Healthcare Provider Details

I. General information

NPI: 1548687437
Provider Name (Legal Business Name): PATCH TESTING CENTERS OF EXCELLENCE- MILFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 BOSTON POST RD SUITE 300
MILFORD CT
06460-3537
US

IV. Provider business mailing address

934 ORANGE CENTER RD
ORANGE CT
06477-1715
US

V. Phone/Fax

Practice location:
  • Phone: 203-301-5860
  • Fax: 203-301-5862
Mailing address:
  • Phone: 617-645-1412
  • Fax: 203-301-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARCO PETRAZZUOLI
Title or Position: OWNER
Credential: M.D.
Phone: 203-301-5860