Provider Demographics
NPI:1639303324
Name:IOVINO, BRANDI LYNN (DO)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYNN
Last Name:IOVINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LYNN
Other - Last Name:COWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:41 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2831
Mailing Address - Country:US
Mailing Address - Phone:860-572-2988
Mailing Address - Fax:
Practice Address - Street 1:41 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2831
Practice Address - Country:US
Practice Address - Phone:860-572-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046497207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine