Provider Demographics
NPI:1467425371
Name:GHISA, ADRIANA S (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:S
Last Name:GHISA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:S
Other - Last Name:PINTEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 STRAITS TPKE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1805
Mailing Address - Country:US
Mailing Address - Phone:203-573-9512
Mailing Address - Fax:203-568-2904
Practice Address - Street 1:305 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-2836
Practice Address - Country:US
Practice Address - Phone:203-729-6641
Practice Address - Fax:203-729-3206
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001395707Medicaid
H35551Medicare UPIN
CT001395707Medicaid