Provider Demographics
NPI:1174577688
Name:EANNIELLO, VICTOR II (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:EANNIELLO
Suffix:II
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 1:99 EAST RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108
Mailing Address - Country:US
Mailing Address - Phone:860-684-8424
Mailing Address - Fax:860-684-8460
Practice Address - Street 1:201 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:STAFFORD SPRINGS
Practice Address - State:CT
Practice Address - Zip Code:06076-9925
Practice Address - Country:US
Practice Address - Phone:860-684-8424
Practice Address - Fax:860-684-8460
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031823174400000X
CT31823207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist