Healthcare Provider Details

I. General information

NPI: 1619956018
Provider Name (Legal Business Name): VINCENT FREDERICK TREMAGLIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 HIGHLAND AVE
WATERBURY CT
06708-3723
US

IV. Provider business mailing address

561 HIGHLAND AVE
WATERBURY CT
06708-3723
US

V. Phone/Fax

Practice location:
  • Phone: 203-757-1579
  • Fax: 203-757-2404
Mailing address:
  • Phone: 203-757-1579
  • Fax: 203-757-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number12199
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: