1053417535 NPI number — AMANDA FAMOLARE VOTTO PA-C

Table of content: AMANDA FAMOLARE VOTTO PA-C (NPI 1053417535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053417535 NPI number — AMANDA FAMOLARE VOTTO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOTTO
Provider First Name:
AMANDA
Provider Middle Name:
FAMOLARE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1053417535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1062 BARNES RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
WALLINGFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06492-2576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-525-1532
Provider Business Mailing Address Fax Number:
203-265-0356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 FRANCIS ST
Provider Second Line Business Practice Location Address:
BRIGHMAN AND WOMEN'S HOSPITAL- HOSPITALIST SERVICE
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-6110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-278-0055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2006

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: 363A00000X , with the licence number:  AP1912 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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