MEDICARE: BIRGIT RANDAZZO MD

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
1	207L00000X	Anesthesiology Physician	044880	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275599680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIRGIT RANDAZZO MD

Provider Business Mailing Address
First Line	:	99 E RIVER DR FL 5
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-7301
Country	:	US
Telephone Number	:	860-282-4022
Fax Number	:	860-282-0834

Provider Business Practice Location Address
First Line	:	99 E RIVER DR FL 5
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-7301
Country	:	US
Telephone Number	:	860-282-4022
Fax Number	:	860-282-0834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	10/13/2009

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Directions to “ BIRGIT RANDAZZO MD” Practice Location

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