Provider Demographics
NPI:1235234618
Name:PISANELLI, PATRICIA A (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:PISANELLI
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 1:463 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05740
Mailing Address - Country:US
Mailing Address - Phone:802-388-9885
Mailing Address - Fax:
Practice Address - Street 1:DISTEFANO MEDICAL GROUP
Practice Address - Street 2:10 WINTHROP STREET
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:802-388-9885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216567208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery