Provider Demographics
NPI:1073747788
Name:ASUNTO, ANN MANTUA (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MANTUA
Last Name:ASUNTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-6805
Mailing Address - Country:US
Mailing Address - Phone:203-327-5111
Mailing Address - Fax:203-327-2991
Practice Address - Street 1:22 5TH ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5012
Practice Address - Country:US
Practice Address - Phone:203-323-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047312207Q00000X
PAMT188452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004234788Medicaid