Individual
MARY T PRONOVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
226 MILL HILL AVE, 3RD FLOOR, BRIDGEPORT, CT 06610-2811
(203) 384-3873
(203) 384-3829
Mailing address
5520 PARK AVE, SUITE 101, TRUMBULL, CT 06611-3463
(203) 254-2381
(203) 255-8515
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
037703
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001377036
—
CT
Enumeration date
03/17/2006
Last updated
09/16/2016
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