Provider Demographics
NPI:1417940271
Name:CERRONE, MARC B (MD)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:B
Last Name:CERRONE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:320 POMFRET ST
Mailing Address - Street 2:PEDIATRIC CENTER
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1836
Mailing Address - Country:US
Mailing Address - Phone:860-928-6541
Mailing Address - Fax:860-963-6343
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:DKH PEDIATRIC CENTER
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1836
Practice Address - Country:US
Practice Address - Phone:860-928-6541
Practice Address - Fax:860-963-6343
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2011-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT037754208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001377549Medicaid
CT001377549Medicaid