Healthcare Provider Details

I. General information

NPI: 1285892703
Provider Name (Legal Business Name): ALLYSON LYNN ROVETTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 MAIN ST STE 201
WATERTOWN CT
06795-2249
US

IV. Provider business mailing address

365 MAIN ST STE 201
WATERTOWN CT
06795-2249
US

V. Phone/Fax

Practice location:
  • Phone: 860-274-2418
  • Fax: 860-274-2986
Mailing address:
  • Phone: 860-274-2418
  • Fax: 860-274-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number050007
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: