Individual
MRS. HANNA KACKIELO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 TOWNE PARK PLZ, NORWICH, CT 06360-2247
(860) 887-0010
(860) 887-0178
Mailing address
1 TOWNE PARK PLZ, NORWICH, CT 06360-2247
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
037461
CT
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
037461
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001374610
—
CT
Enumeration date
05/08/2006
Last updated
06/19/2020
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