Provider Demographics
NPI:1366487613
Name:DICORATO, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:DICORATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STEVENS ST
Mailing Address - Street 2:NORWALK HOSPITAL - 5TH FLOOR LABORATORY
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3852
Mailing Address - Country:US
Mailing Address - Phone:203-852-2649
Mailing Address - Fax:203-899-1518
Practice Address - Street 1:24 STEVENS ST
Practice Address - Street 2:NORWALK HOSPITAL - 5TH FLOOR LABORATORY
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3852
Practice Address - Country:US
Practice Address - Phone:203-852-2649
Practice Address - Fax:203-899-1518
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032966207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061113482OtherUNITED HEALTHCARE#
CT061113482OtherOXFORD#
CTF54665Medicare UPIN
CT9624103OtherCIGNA#
CT001329665P1OtherBLUE CARE FAMILY#
CT2200000414Medicare ID - Type UnspecifiedMEDICARE#
CT0004398243OtherAETNA/USHC#
CT713482OtherCONNECTICARE#
CT022040OtherHEALTHNET#
CT001329665Medicaid
CT061113482OtherPHCS#
CT500HBL073CT01OtherBCBS GROUP#