Provider Demographics
NPI:1356376222
Name:MACANNUCO-WINSLOW, ANNETTE K (MD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:K
Last Name:MACANNUCO-WINSLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:K
Other - Last Name:MACANNUCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06034
Mailing Address - Country:US
Mailing Address - Phone:860-696-2843
Mailing Address - Fax:860-696-2845
Practice Address - Street 1:65 MEMORIAL RD
Practice Address - Street 2:SUITE 435
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-696-2843
Practice Address - Fax:860-696-2845
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037203208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001057Medicare PIN
CTG64622Medicare UPIN