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General NPI Number Information
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NPI Number | 1235164427
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Entity Type | Individual
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Provider Name | JOSEPH BLAISE GUARNACCIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 350 SEYMOUR AVE # 1C
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City | DERBY
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State | CT
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Zip | 06418-1336
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Country | US
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Telephone | 203-732-1290
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Fax | 203-732-1299
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Provider Business Mailing Address
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Address Line | 137 COLD SPRING ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-2205
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Country | US
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Telephone | 203-676-7436
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Fax | 203-732-1299
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 1045N
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 031179
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License Number State | CT
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