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NPI Code Detail

MEDICARE: FAUSTO PETRUZZIELLO MD

MEDICARE: FAUSTO PETRUZZIELLO 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
1207R00000XInternal Medicine Physician036943CT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00441640OTHERCTRAILROADMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12V9255OTHERCTHEALTHNET
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4010036943CT01OTHERCTANTHEM BCBS
5010036943CT07OTHERCTANTHEM BCBS
65941638OTHERCTAETNA
7754451Q040OTHERCTCONNECTICARE
8P3846616OTHERCTOXFORD HEALTH PLAN
9754451OTHERCTCONNECTICARE

General Provider Information

NPI Number : 1316933419
Entity Type Code : Individual
Provider Name (Legal Business Name) : FAUSTO PETRUZZIELLO MD
Provider Business Mailing Address
First Line : 52 WASHINGTON AVE
Second Line : SUITE 4
City : NORTH HAVEN
State : CT
Zip : 06473-1724
Country : US
Telephone Number : 203-672-2800
Fax Number : 203-672-2801
Provider Business Practice Location Address
First Line : 52 WASHINGTON AVE
Second Line : SUITE 4
City : NORTH HAVEN
State : CT
Zip : 06473-1724
Country : US
Telephone Number : 203-672-2800
Fax Number : 203-672-2801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 07/22/2016

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Directions to “ FAUSTO PETRUZZIELLO MD” Practice Location

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