Provider Demographics
NPI:1417991688
Name:VALLETTA, GERALD A (MD)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:A
Last Name:VALLETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2247 EAST MAIN STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705
Mailing Address - Country:US
Mailing Address - Phone:203-757-3486
Mailing Address - Fax:206-757-3723
Practice Address - Street 1:2247 EAST MAIN STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705
Practice Address - Country:US
Practice Address - Phone:203-757-3486
Practice Address - Fax:206-757-3723
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT035043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001350438Medicaid
1100009288Medicare ID - Type Unspecified