Provider Demographics
NPI:1659393247
Name:OLCESE, PAOLO (MD)
Entity Type:Individual
Prefix:
First Name:PAOLO
Middle Name:
Last Name:OLCESE
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 1:385 MAIN ST S, C/O NVRA IMAGING NETWORK
Mailing Address - Street 2:UNION SQUARE BLDG #1
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4240
Mailing Address - Country:US
Mailing Address - Phone:203-264-7999
Mailing Address - Fax:203-264-7477
Practice Address - Street 1:385 MAIN ST S, C/O NVRA IMAGING NETWORK
Practice Address - Street 2:UNION SQUARE
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4240
Practice Address - Country:US
Practice Address - Phone:203-264-7999
Practice Address - Fax:203-264-7477
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0391542085U0001X, 2085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001391549Medicaid
CT300003219Medicare ID - Type UnspecifiedPDI
CT300003000Medicare ID - Type UnspecifiedDIA
CT300003002Medicare ID - Type UnspecifiedMRI
CT001391549Medicaid
CT300003001Medicare ID - Type UnspecifiedDIS
CT300002998Medicare ID - Type UnspecifiedNVRA
CT300003003Medicare ID - Type UnspecifiedHIA
CT300003514Medicare ID - Type UnspecifiedNDI
CT300002999Medicare ID - Type UnspecifiedNVCI