Individual
DR. FONDA GRAVINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
99 WOODLAND ST, HARTFORD, CT 06105-1207
(860) 714-4212
(860) 714-8080
Mailing address
99 WOODLAND ST, HARTFORD, CT 06105-1207
(860) 714-4212
(860) 714-8080
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
042931
CT
207Q00000X
Family Medicine Physician
Primary
042931
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952396020
—
CT
Enumeration date
09/15/2005
Last updated
09/09/2021
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