Healthcare Provider Details

I. General information

NPI: 1225698574
Provider Name (Legal Business Name): ALISON MAI MARDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 LITCHFIELD ST STE G02
TORRINGTON CT
06790-6669
US

IV. Provider business mailing address

538 LITCHFIELD ST STE G02
TORRINGTON CT
06790-6669
US

V. Phone/Fax

Practice location:
  • Phone: 860-489-5068
  • Fax:
Mailing address:
  • Phone: 860-489-5068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4495
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: