Individual
DR. PETER PAUL BERTOLOZZI JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
255 MICHELLE LN, APT 306, GROTON, CT 06340-4239
(617) 448-1589
Mailing address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
49914
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5101017291
EDUCATION LISCENCE
MI
01
—
5315031607
CONTROLLED SUBSTANCE LIS
MI
Enumeration date
01/27/2008
Last updated
03/07/2019
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