Provider Demographics
NPI:1487976676
Name:JOHN J GIACCHETTO MD PC
Entity type:Organization
Organization Name:JOHN J GIACCHETTO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIACCHETTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-889-1116
Mailing Address - Street 1:105 WAWECUS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2146
Mailing Address - Country:US
Mailing Address - Phone:860-889-1116
Mailing Address - Fax:860-889-2032
Practice Address - Street 1:105 WAWECUS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2146
Practice Address - Country:US
Practice Address - Phone:860-889-1116
Practice Address - Fax:860-889-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026485207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
797371OtherCONNECTICARE
0461209OtherAETNA
030927OtherHEALTHNET
CT010026485CT03OtherANTHEM BLUE CROSS AND BLUE SHIELD
NLS089OtherOXFORD
CT001264853Medicaid
0461209OtherAETNA
CT0465450001Medicare NSC
200000527Medicare PIN