Provider Demographics
NPI:1437195617
Name:DEDONATO, JOSEPH A (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:DEDONATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06039
Mailing Address - Country:US
Mailing Address - Phone:800-795-5820
Mailing Address - Fax:
Practice Address - Street 1:50 HOSPITAL HILL DRIVE
Practice Address - Street 2:ER DEPARTMENT
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069
Practice Address - Country:US
Practice Address - Phone:800-795-5820
Practice Address - Fax:616-975-9728
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031458207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
E13700Medicare UPIN
CTP00087344Medicare PIN