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General NPI Number Information
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NPI Number | 1144595372
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Entity Type | Individual
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Provider Name | MICHAEL NANNA MD, MHS
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Gender | Male
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 20 YORK ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-688-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 333 CEDAR STREET PO BOX 208017
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City | NEW HAVEN
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State | CT
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Zip | 06520-8017
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 53975
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 53975
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 53975
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License Number State | CT
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