Provider Demographics
NPI:1184967432
Name:GUARDINO, KAITLYN MARIE (MD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:GUARDINO
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 1:945 MAIN ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6064
Mailing Address - Country:US
Mailing Address - Phone:860-646-1900
Mailing Address - Fax:860-645-3441
Practice Address - Street 1:945 MAIN ST
Practice Address - Street 2:SUITE 308
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6064
Practice Address - Country:US
Practice Address - Phone:860-646-1900
Practice Address - Fax:860-645-3441
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine