Provider Demographics
NPI:1699014399
Name:PRIVITERA, JOSEPH HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HENRY
Last Name:PRIVITERA
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 1:175 OLD MOUNT TOM RD
Mailing Address - Street 2:
Mailing Address - City:BANTAM
Mailing Address - State:CT
Mailing Address - Zip Code:06750-1302
Mailing Address - Country:US
Mailing Address - Phone:860-567-0734
Mailing Address - Fax:
Practice Address - Street 1:175 OLD MOUNT TOM RD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-1302
Practice Address - Country:US
Practice Address - Phone:860-567-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0155212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology