Provider Demographics
NPI:1285892703
Name:ROVETTO, ALLYSON LYNN (MD)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:LYNN
Last Name:ROVETTO
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 1:365 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2249
Mailing Address - Country:US
Mailing Address - Phone:860-274-2418
Mailing Address - Fax:860-274-2986
Practice Address - Street 1:365 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2249
Practice Address - Country:US
Practice Address - Phone:860-274-2418
Practice Address - Fax:860-274-2986
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050007208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1154371OtherUSA
CTP4362830OtherOXFORD
CT050007OtherCONNECTICARAE
CTPENDINGOtherRR MEDICARE
CT1120325OtherCIGNA
CT618823OtherWELLCARE
CT010050007CT01OtherANTHEM BCBS CT
CT1120325OtherGREAT WEST
CT008032569Medicaid
CT9823685OtherAETNA
CT1120325OtherGREAT WEST