Provider Demographics
NPI:1548378813
Name:PESCE, JOSEPH RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RAYMOND
Last Name:PESCE
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 1:4699 MAIN ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-372-8949
Mailing Address - Fax:203-374-9296
Practice Address - Street 1:4699 MAIN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-372-8949
Practice Address - Fax:203-374-9296
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013383207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D02764Medicare UPIN
CTP00281464Medicare ID - Type Unspecified