Provider Demographics
NPI:1174535561
Name:VERISSIMO, ANA M (MD)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:M
Last Name:VERISSIMO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:60 HARTLAND STREET - CBO
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3250
Mailing Address - Country:US
Mailing Address - Phone:860-837-5615
Mailing Address - Fax:860-837-5613
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:DIVISION OF PAIN MEDICINE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-837-5207
Practice Address - Fax:860-837-5209
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT031426208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG42465Medicare UPIN