Provider Demographics
NPI:1407832959
Name:CASSANO, VICTORIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:A
Last Name:CASSANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:HARTFORD MEDICAL GROUP
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01098-1086
Mailing Address - Country:US
Mailing Address - Phone:508-595-0531
Mailing Address - Fax:508-829-5367
Practice Address - Street 1:1260 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4362
Practice Address - Country:US
Practice Address - Phone:860-529-1100
Practice Address - Fax:860-721-9552
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0427102083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001427104Medicaid
CT840000013Medicare ID - Type Unspecified
I13733Medicare UPIN