Provider Demographics
NPI:1518259175
Name:TARTARONE, THERESA (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:TARTARONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST S
Mailing Address - Street 2:BUILDING 2, SUITE 100
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4237
Mailing Address - Country:US
Mailing Address - Phone:203-262-1911
Mailing Address - Fax:203-262-9434
Practice Address - Street 1:900 MAIN ST S
Practice Address - Street 2:BUILDING 2, SUITE 100
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4237
Practice Address - Country:US
Practice Address - Phone:203-262-1911
Practice Address - Fax:203-262-9434
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine