Organization
ANTHONY D CIARDELLA M.D. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY D CIARDELLA M.D. (PRESIDENT)
(860) 621-6759
Entity
Organization
Contact information
Practice address
360-14 N MAIN ST, SOUTHINGTON, CT 06489
(860) 621-6759
(860) 621-0117
Mailing address
360-14 N MAIN ST, SOUTHINGTON, CT 06489
(860) 621-6759
(860) 621-0117
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
024620
CT
363LP2300X
Primary Care Nurse Practitioner
34236
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C02732
MEDICARE GROUP #
CT
Enumeration date
07/17/2007
Last updated
09/12/2007
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