Provider Demographics
NPI:1831538339
Name:PANNONE, CRAIG (ND)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:PANNONE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 EAST ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-3417
Mailing Address - Country:US
Mailing Address - Phone:860-747-1025
Mailing Address - Fax:860-310-1442
Practice Address - Street 1:307 EAST ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-3417
Practice Address - Country:US
Practice Address - Phone:860-747-1025
Practice Address - Fax:860-310-1442
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000498175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath