Provider Demographics
NPI:1235164427
Name:GUARNACCIA, JOSEPH BLAISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BLAISE
Last Name:GUARNACCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 COLD SPRING ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2205
Mailing Address - Country:US
Mailing Address - Phone:203-676-7436
Mailing Address - Fax:203-732-1299
Practice Address - Street 1:350 SEYMOUR AVE # 1C
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1336
Practice Address - Country:US
Practice Address - Phone:203-732-1290
Practice Address - Fax:203-732-1299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1045N2084N0400X
CT0311792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001311795Medicaid
CTE86371Medicare UPIN
CT001311795Medicaid