Individual
MATTHEW VANCE PENNACCHIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
521 BOSTON POST RD, ORANGE, CT 06477-3506
(203) 529-3271
Mailing address
1700 BROADBRIDGE AVE UNIT B27, STRATFORD, CT 06614-5493
(203) 722-3028
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5310
CT
Other
Enumeration date
05/02/2021
Last updated
10/11/2021
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