Provider Demographics
NPI:1033109095
Name:COLELLA, DANETTE T
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:T
Last Name:COLELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BOULDER POINT DR STE 1
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3170
Mailing Address - Country:US
Mailing Address - Phone:603-536-4000
Mailing Address - Fax:603-536-4000
Practice Address - Street 1:101 BOULDER POINT DR STE 1
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3170
Practice Address - Country:US
Practice Address - Phone:603-536-4000
Practice Address - Fax:603-536-4000
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159758208000000X
WI64573208000000X
NH19572208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100051863Medicaid
MA3191664Medicaid
MA710585OtherHVD PILGRIM HEALTH CARE
MA7457583OtherAETNA
MA0016422OtherNEIGHBORHOOD HLTH PLAN
MA042297845OtherGREAT WEST HEALTH CARE
MA42310OtherFALLON
MA042297845OtherHCVM
MA159758OtherTUFTS
MAB10361201OtherCIGNA
MA042297845OtherGIC UNICARE
MA042297845OtherPRIVATE HEALTHCARE SYSTEM
MA042297845OtherTRICARE
MAJ19947OtherBCBS
MA042297845OtherUNITED HEALTH CARE
MA042297845OtherDOC FIRST
NH3118251Medicaid
MA042297845OtherPRIVATE HEALTHCARE SYSTEM