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General NPI Number Information
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NPI Number | 1477059772
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Entity Type | Individual
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Provider Name | JUSTIN D'ADDARIO MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 1402 S GRAND BLVD # M260
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1004
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Country | US
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Telephone | 845-656-7412
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Fax |
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Provider Business Mailing Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06030-8082
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Country | US
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Telephone | 606-798-0808
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Fax | 860-679-1430
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 075022
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License Number State | CT
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