Individual
VINCENT J MICCOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
245 ALVORD PARK ROAD, TORRINGTON, CT 06790
(860) 482-8539
(860) 482-0258
Mailing address
245 ALVORD PARK ROAD, TORRINGTON, CT 06790
(860) 482-8539
(860) 482-0258
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
000949
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000949
CONNECTICARE
CT
01
—
290000949CT01
BC
CT
Enumeration date
05/17/2006
Last updated
06/17/2021
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