Individual
JO-ANNE PASSALACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2150 BLACK ROCK TPKE, 2ND FLOOR, FAIRFIELD, CT 06825-3239
(203) 384-0451
(203) 384-0472
Mailing address
2150 BLACK ROCK TPKE, 2ND FLOOR, FAIRFIELD, CT 06825-3239
(203) 384-0451
(203) 384-0472
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
035850
CT
207RI0200X
Infectious Disease Physician
Primary
035850
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001358507
—
CT
Enumeration date
03/20/2006
Last updated
12/10/2015
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