Provider Demographics
NPI:1518938281
Name:PIETROPAOLI, JOHN ANTHONY JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:PIETROPAOLI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:495 HAWLEY LN
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1514
Mailing Address - Country:US
Mailing Address - Phone:203-375-2861
Mailing Address - Fax:203-375-5615
Practice Address - Street 1:360 TOLLAND TPKE STE 1A
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1759
Practice Address - Country:US
Practice Address - Phone:860-533-6551
Practice Address - Fax:860-533-6552
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00547572086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008061978Medicaid
CTD400209153Medicare PIN
G98307Medicare UPIN
DCK9740001OtherBLUE CROSS
MD149P361GMedicare ID - Type Unspecified
9271OtherUNITED HEALTHCARE