MEDICARE: ALLYSON LYNN ROVETTO M.D.

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	208000000X	Pediatrics Physician	050007	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	PENDING	OTHER	CT	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1154371	OTHER	CT	USA
2	P4362830	OTHER	CT	OXFORD
3	050007	OTHER	CT	CONNECTICARAE
5	1120325	OTHER	CT	CIGNA
6	618823	OTHER	CT	WELLCARE
7	010050007CT01	OTHER	CT	ANTHEM BCBS CT
8	1120325	OTHER	CT	GREAT WEST
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	9823685	OTHER	CT	AETNA

General Provider Information

NPI Number	:	1285892703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON LYNN ROVETTO M.D.

Provider Business Mailing Address
First Line	:	365 MAIN ST STE 201
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-2249
Country	:	US
Telephone Number	:	860-274-2418
Fax Number	:	860-274-2986

Provider Business Practice Location Address
First Line	:	365 MAIN ST STE 201
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-2249
Country	:	US
Telephone Number	:	860-274-2418
Fax Number	:	860-274-2986

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	01/18/2022

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