Provider Demographics
NPI:1639353907
Name:DONNA R. CRISCENZO, M.D., LLC
Entity Type:Organization
Organization Name:DONNA R. CRISCENZO, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRISCENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-458-2888
Mailing Address - Street 1:199 GOOSE LN
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2115
Mailing Address - Country:US
Mailing Address - Phone:203-458-2888
Mailing Address - Fax:203-458-2889
Practice Address - Street 1:199 GOOSE LN
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2115
Practice Address - Country:US
Practice Address - Phone:203-458-2888
Practice Address - Fax:203-458-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB83447Medicare UPIN