Provider Demographics
NPI:1477667392
Name:DILULLO, ANTHONY A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:DILULLO
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 1:491 GOLD STARY HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340
Mailing Address - Country:US
Mailing Address - Phone:860-445-5107
Mailing Address - Fax:860-448-1368
Practice Address - Street 1:491 GOLD STARY HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-445-5107
Practice Address - Fax:860-448-1368
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028740207V00000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E67609Medicare UPIN
160001624Medicare ID - Type Unspecified