Individual
ANNETTE VANNILAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
191 POST RD W, WESTPORT, CT 06880-4625
(860) 545-9560
Mailing address
191 POST RD W, WESTPORT, CT 06880-4625
(860) 545-9560
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301103398
MI
2080P0206X
Pediatric Gastroenterology Physician
Primary
75930
CT
2080P0206X
Pediatric Gastroenterology Physician
MD0000054575
TN
261QP2300X
Primary Care Clinic/Center
4301103398
MI
Other
Enumeration date
06/17/2013
Last updated
09/04/2024
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