Provider Demographics
NPI:1417147406
Name:VISCHIO, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:VISCHIO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:195 EASTERN BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1208
Mailing Address - Country:US
Mailing Address - Phone:860-246-4260
Mailing Address - Fax:860-430-9770
Practice Address - Street 1:195 EASTERN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1208
Practice Address - Country:US
Practice Address - Phone:860-246-4260
Practice Address - Fax:860-430-9770
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2020-03-02
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Provider Licenses
StateLicense IDTaxonomies
CT067435207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004167707Medicaid
CT004167707Medicaid
CT350000995Medicare PIN