Provider Demographics
NPI:1376569392
Name:ARDOLINO, SALLY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:ANN
Last Name:ARDOLINO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1007 FARMINGTON AVENUE
Mailing Address - Street 2:STE 9
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107
Mailing Address - Country:US
Mailing Address - Phone:860-586-7825
Mailing Address - Fax:860-586-7827
Practice Address - Street 1:1007 FARMINGTON AVENUE
Practice Address - Street 2:STE 9
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-586-7825
Practice Address - Fax:860-586-7827
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2009-06-15
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Provider Licenses
StateLicense IDTaxonomies
CT026360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83440Medicare UPIN