Provider Demographics
NPI:1366430886
Name:PASTUSZAK, WILLIAM THEODORE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THEODORE
Last Name:PASTUSZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:99 E RIVER DR
Mailing Address - Street 2:5TH FL
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3288
Mailing Address - Country:US
Mailing Address - Phone:860-282-4137
Mailing Address - Fax:860-289-0742
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-8000
Practice Address - Country:US
Practice Address - Phone:860-545-2249
Practice Address - Fax:860-545-2204
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016441207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001274787Medicaid
E79252Medicare UPIN
CT001274787Medicaid