Provider Demographics
NPI:1962647743
Name:PEZZINO, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:PEZZINO
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 1:330 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1851
Mailing Address - Country:US
Mailing Address - Phone:203-518-4888
Mailing Address - Fax:203-518-4889
Practice Address - Street 1:330 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1851
Practice Address - Country:US
Practice Address - Phone:203-518-4888
Practice Address - Fax:203-518-4889
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261336208100000X
CT051098208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation