Provider Demographics
NPI:1437389715
Name:AVELLINO, MARIA DIANA (CNM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DIANA
Last Name:AVELLINO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 WEST CENTER ST
Mailing Address - Street 2:MANCHESTER OB-GYN ASSOC
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-649-1120
Mailing Address - Fax:860-645-8541
Practice Address - Street 1:388 WEST CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-649-1120
Practice Address - Fax:860-645-8541
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2260816367A00000X
CT000318367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife