Provider Demographics
NPI:1073539367
Name:MASTROIANNI, PATRICK PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:PAUL
Last Name:MASTROIANNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5445
Mailing Address - Country:US
Mailing Address - Phone:203-336-3306
Mailing Address - Fax:203-336-5802
Practice Address - Street 1:340 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5445
Practice Address - Country:US
Practice Address - Phone:203-336-3306
Practice Address - Fax:203-336-5802
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0534330OtherAETNA PROVIDER ID
CT010023870CT05OtherANTHEM BC PROVIDER ID
CT002199OtherHEALTHNET PROVIDER ID
CT061386448OtherBERKLEY CARE PROVIDER ID
CTZS254OtherOXFORD HEALTH PROV. ID
CT002199OtherHEALTHNET PROVIDER ID
CT0534330OtherAETNA PROVIDER ID