Provider Demographics
NPI:1770691552
Name:PESCE, KATHERINE JANE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JANE
Last Name:PESCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4699 MAIN ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-372-8949
Mailing Address - Fax:203-372-9296
Practice Address - Street 1:4699 MAIN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-372-8949
Practice Address - Fax:203-372-9296
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT039261207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001392612Medicaid
H26243Medicare UPIN
CTP00287062Medicare ID - Type Unspecified