Provider Demographics
NPI:1073598538
Name:INZUCCHI, SILVIO EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:SILVIO
Middle Name:EDWARD
Last Name:INZUCCHI
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 1:300 GEORGE STREET 6TH FLOOR
Mailing Address - Street 2:PO BOX 9805
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06536-0805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:DANA BUILDING - 3RD FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-737-1932
Practice Address - Fax:203-785-3588
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028586207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001285867Medicaid
B39326Medicare UPIN
CT110005325Medicare ID - Type Unspecified