Provider Demographics
NPI:1881662443
Name:GIANNINI, KRISTIN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:GIANNINI
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:PO BOX 3249
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2149
Mailing Address - Country:US
Mailing Address - Phone:860-872-2289
Mailing Address - Fax:860-896-1425
Practice Address - Street 1:520 HARTFORD TPKE
Practice Address - Street 2:SUITE N
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5037
Practice Address - Country:US
Practice Address - Phone:860-872-8321
Practice Address - Fax:860-875-6271
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine