Provider Demographics
NPI:1104813955
Name:GIROLAMO, MARISSA (DPM)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:GIROLAMO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 SUMMER ST STE 202
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5510
Mailing Address - Country:US
Mailing Address - Phone:203-323-1171
Mailing Address - Fax:203-323-4649
Practice Address - Street 1:1234 SUMMER ST STE 202
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5510
Practice Address - Country:US
Practice Address - Phone:203-323-1711
Practice Address - Fax:203-323-4649
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000558213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT480000468OtherMEDICARE ID#
CT022112OtherHEALTHNET
CT030000558CT01OtherBLUE CROSS
CT0328216002OtherCIGNA
CT95809OtherAETNA HEALTH PLAN
CT022112OtherHEALTHNET