Provider Demographics
NPI:1811917289
Name:MONGILLO, FRANK JOSEPH III (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JOSEPH
Last Name:MONGILLO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2006
Mailing Address - Country:US
Mailing Address - Phone:203-776-6845
Mailing Address - Fax:203-777-9020
Practice Address - Street 1:26 ELM STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2006
Practice Address - Country:US
Practice Address - Phone:203-776-6845
Practice Address - Fax:203-777-9020
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
035706OtherCONNECTICARE
00135706200OtherBLUE CARE FAMILY
C702OtherBCBS
1027208OtherAETNA
01036706OtherCIGNA
0443076OtherUNITED HEALTHCARE
943290OtherHEALTH NET
P693817OtherOXFORD
G42267Medicare UPIN