Provider Demographics
NPI:1023057114
Name:PETRAZZUOLI, MARCO (MD)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:PETRAZZUOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 BOSTON POST RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3537
Mailing Address - Country:US
Mailing Address - Phone:203-301-5860
Mailing Address - Fax:203-301-5861
Practice Address - Street 1:849 BOSTON POST RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3537
Practice Address - Country:US
Practice Address - Phone:203-301-5860
Practice Address - Fax:203-301-5861
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT048179207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG85551Medicare UPIN