Provider Demographics
NPI:1841363215
Name:VISCONTI, ANN MARIE (PAC)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:VISCONTI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-341-1889
Mailing Address - Fax:413-344-4747
Practice Address - Street 1:294 FIRST STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-341-1889
Practice Address - Fax:413-344-4747
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP915207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S70179Medicare UPIN
V1AP0947Medicare ID - Type Unspecified