Healthcare Provider Details

I. General information

NPI: 1386730687
Provider Name (Legal Business Name): ROCCO MARANDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511
US

IV. Provider business mailing address

19 DRAZEN DRIVE SOUTH
NORTH HAVEN CT
06473
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3538
  • Fax: 203-867-5461
Mailing address:
  • Phone: 203-234-9518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number026971
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: