Provider Demographics
NPI:1477012607
Name:MERITZ-SACCENTE, DEVON ANDREW (MD, DIPHE, MA, BS,)
Entity Type:Individual
Prefix:DR
First Name:DEVON
Middle Name:ANDREW
Last Name:MERITZ-SACCENTE
Suffix:
Gender:M
Credentials:MD, DIPHE, MA, BS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06102-8000
Mailing Address - Country:US
Mailing Address - Phone:860-972-0549
Mailing Address - Fax:860-545-5221
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-8000
Practice Address - Country:US
Practice Address - Phone:860-972-0549
Practice Address - Fax:860-545-5221
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
CT72023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program