Individual
DR. PETER ANTHONY IMMORDINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-5386
(860) 679-5500
Mailing address
100 RIVER RD, ESSEX, CT 06426-1306
(860) 767-3194
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
115497
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001154970
—
CT
Enumeration date
09/08/2010
Last updated
09/08/2010
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