Provider Demographics
NPI:1831292937
Name:MASSUCCO, ANNE (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MASSUCCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WOODLAND ST
Mailing Address - Street 2:SUITE 31
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2372
Mailing Address - Country:US
Mailing Address - Phone:860-728-1212
Mailing Address - Fax:860-724-5224
Practice Address - Street 1:19 WOODLAND ST
Practice Address - Street 2:SUITE 31
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2372
Practice Address - Country:US
Practice Address - Phone:860-728-1212
Practice Address - Fax:860-724-5224
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT027586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38389Medicare UPIN