Provider Demographics
NPI:1114961604
Name:PIRRELLO, JON R (M D)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:R
Last Name:PIRRELLO
Suffix:
Gender:M
Credentials:M D
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE #2102
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-7128
Mailing Address - Fax:860-714-8076
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE #2102
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-714-7128
Practice Address - Fax:860-714-8076
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2006-00634208600000X
CT53626208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery