Provider Demographics
NPI:1801862602
Name:PALAZZO, REGINA M (MD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:PALAZZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6 BUSINESS PARK DR
Mailing Address - Street 2:202
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2988
Mailing Address - Country:US
Mailing Address - Phone:203-208-2395
Mailing Address - Fax:203-433-4638
Practice Address - Street 1:6 BUSINESS PARK DR
Practice Address - Street 2:202
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2988
Practice Address - Country:US
Practice Address - Phone:203-208-2395
Practice Address - Fax:203-433-4638
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0349232080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001349233Medicaid
370001562Medicare ID - Type Unspecified
E57998Medicare UPIN