Provider Demographics
NPI:1437144763
Name:SARDELLA, WILLIAM VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VINCENT
Last Name:SARDELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 425
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-548-7336
Mailing Address - Fax:860-524-2651
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE 425
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-548-7336
Practice Address - Fax:860-524-2651
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026909208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT16199OtherHEALTH NEW ENGLAND
CT782089OtherAETNA
CT0084700 004OtherCIGNA
CT010026909CT01OtherANTHEM BCBS
CTP1056424OtherOXFORD
CT0S2507OtherHEALTH NET
MA3163695Medicaid
CT026909OtherCONNECTICARE
CTP1056424OtherOXFORD