Provider Demographics
NPI:1114920832
Name:AMATO, DINA (MD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:AMATO
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 1:26 SCHOOLHOUSE DR UNIT 303
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1438
Mailing Address - Country:US
Mailing Address - Phone:401-480-6695
Mailing Address - Fax:
Practice Address - Street 1:155 HAZARD AVE STE 14
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4586
Practice Address - Country:US
Practice Address - Phone:860-749-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT62130208000000X
RIMD 09765208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDE28689Medicaid
RIDE28689Medicaid