Provider Demographics
NPI:1285673137
Name:ARDOLINO, HARRY ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ANTHONY
Last Name:ARDOLINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2924
Mailing Address - Country:US
Mailing Address - Phone:203-481-8444
Mailing Address - Fax:203-483-0176
Practice Address - Street 1:6 BUSINESS PARK DR
Practice Address - Street 2:SUITE 301
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2924
Practice Address - Country:US
Practice Address - Phone:203-481-8444
Practice Address - Fax:203-483-0176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT024308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB84301Medicare UPIN