Individual
DR. MARCELLO MICHAEL DISTASIO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
310 CEDAR ST, NEW HAVEN, CT 06510-3218
(203) 785-3624
Mailing address
75 FRANCIS ST, BOSTON, MA 02115-6110
(617) 732-7510
(617) 277-9015
Taxonomy
Speciality
Code
Description
License number
State
207ZN0500X
Neuropathology Physician
Primary
64362
CT
207ZP0101X
Anatomic Pathology Physician
64362
CT
Other
Enumeration date
04/15/2014
Last updated
11/02/2020
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