1588917918 NPI number — KATHLEEN MARY ORAZIETTI PA

Table of content: HENRY LADOKE (NPI 1619856036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588917918 NPI number — KATHLEEN MARY ORAZIETTI PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORAZIETTI
Provider First Name:
KATHLEEN
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588917918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
917 BRIDGEPORT AVENUE
Provider Second Line Business Mailing Address:
C/O ROBERT D. RUSSO, MD & ASSOCIATES RADIOLOGY, PC
Provider Business Mailing Address City Name:
SHELTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-683-4683
Provider Business Mailing Address Fax Number:
203-926-1415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2660 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-683-4540
Provider Business Practice Location Address Fax Number:
203-926-1410
Provider Enumeration Date:
10/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  000218 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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