Provider Demographics
NPI:1174548762
Name:PASSARELLI, MARIANNE (MD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:PASSARELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:
Other - Last Name:GARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:789 HOWARD AVE # FMP300
Mailing Address - Street 2:YALE UNIVERSITY DEPARTMENT OF UROLOGY PO BOX 208058
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1304
Mailing Address - Country:US
Mailing Address - Phone:203-785-2815
Mailing Address - Fax:203-764-7833
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-785-2815
Practice Address - Fax:203-764-7833
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033640208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F26197Medicare UPIN
340000236Medicare ID - Type Unspecified