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NPI Code Detail

MEDICARE: COREY PAGNOTTA DO

MEDICARE:   COREY  PAGNOTTA  DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program081602
2208000000XPediatrics Physician2021025563MO
32080P0206XPediatric Gastroenterology Physician081602CT

General Provider Information

NPI Number : 1053933150
Entity Type Code : Individual
Provider Name (Legal Business Name) : COREY PAGNOTTA DO
Provider Business Mailing Address
First Line : 282 WASHINGTON ST
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3322
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 282 WASHINGTON ST
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3322
Country : US
Telephone Number : 860-545-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2020
Last Update Date : 12/01/2025

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