Individual
ROBERT LOUIS VENTULETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 271-4364
(860) 444-5114
Mailing address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 271-4364
(860) 444-5114
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1680
SC
363AM0700X
Medical Physician Assistant
Primary
2933
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1236PA
—
SC
01
—
1680
STATE LICENSE
SC
Enumeration date
08/30/2011
Last updated
07/10/2013
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