Provider Demographics
NPI:1043226277
Name:MARCONI, JEANNE M (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:MARCONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:40 CROSS ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4647
Mailing Address - Country:US
Mailing Address - Phone:203-229-2029
Mailing Address - Fax:203-840-9055
Practice Address - Street 1:40 CROSS ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4647
Practice Address - Country:US
Practice Address - Phone:203-229-2029
Practice Address - Fax:203-840-9055
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT030666208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008008165Medicaid