Provider Demographics
NPI:1073690848
Name:DELLACONO, FRANK R (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:R
Last Name:DELLACONO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:214 FARMHOLME RD
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-2209
Mailing Address - Country:US
Mailing Address - Phone:860-535-9051
Mailing Address - Fax:
Practice Address - Street 1:201 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2805
Practice Address - Country:US
Practice Address - Phone:860-536-3078
Practice Address - Fax:860-536-4915
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT034694207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG05867Medicare UPIN