Provider Demographics
NPI:1275599680
Name:RANDAZZO, BIRGIT (MD)
Entity Type:Individual
Prefix:
First Name:BIRGIT
Middle Name:
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BIRGIT
Other - Middle Name:
Other - Last Name:VOGL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:99 E RIVER DR FL 5
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7301
Mailing Address - Country:US
Mailing Address - Phone:860-282-4022
Mailing Address - Fax:860-282-0834
Practice Address - Street 1:99 E RIVER DR FL 5
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-7301
Practice Address - Country:US
Practice Address - Phone:860-282-4022
Practice Address - Fax:860-282-0834
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044880207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI06575Medicare UPIN