Healthcare Provider Details

I. General information

NPI: 1427052380
Provider Name (Legal Business Name): JOHN J GIACCHETTO MD PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WAWECUS ST SUITE 2
NORWICH CT
06360-2146
US

IV. Provider business mailing address

105 WAWECUS ST SUITE 2
NORWICH CT
06360-2146
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-1116
  • Fax: 860-889-2032
Mailing address:
  • Phone: 860-889-1116
  • Fax: 860-889-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number026485
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: