Individual
IAN GRAGNOLATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
836 FARMINGTON AVE STE 207, WEST HARTFORD, CT 06119-1551
(860) 232-9911
Mailing address
25 ROBERTS ST, WINDSOR LOCKS, CT 06096-2113
(860) 970-4913
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6212
CT
Other
Enumeration date
06/06/2023
Last updated
08/22/2023
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