Provider Demographics
NPI:1851496061
Name:DEFUSCO, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DEFUSCO
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 1:80 FISHER DRIVE
Mailing Address - Street 2:HARTFORD HOSPITAL CANCER CENTER
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3798
Mailing Address - Country:US
Mailing Address - Phone:860-674-0088
Mailing Address - Fax:
Practice Address - Street 1:80 FISHER DRIVE
Practice Address - Street 2:HARTFORD HOSPITAL CANCER CENTER
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-674-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023881207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00123881502Medicaid
CTE45122Medicare UPIN
CT00123881502Medicaid