Individual
ANN MANTUA ASUNTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
22 5TH ST, STAMFORD, CT 06905-5012
(203) 323-8160
Mailing address
805 ATLANTIC ST, STAMFORD, CT 06902-6805
(203) 327-5111
(203) 327-2991
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
047312
CT
207Q00000X
Family Medicine Physician
MT188452
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004234788
—
CT
Enumeration date
05/08/2009
Last updated
11/10/2023
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