Individual
DR. EDWARD H. JACCOMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
87 GRANDVIEW AVE STE A, WATERBURY, CT 06708-2523
(203) 574-2020
(203) 596-2230
Mailing address
87 GRANDVIEW AVE STE A, WATERBURY, CT 06708-2523
(203) 574-2020
(203) 596-2230
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
011998
ME
207W00000X
Ophthalmology Physician
56003
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134050099
—
ME
05
—
1982681367
—
CT
Enumeration date
12/28/2005
Last updated
09/14/2018
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