Provider Demographics
NPI:1194724054
Name:SQUATRITO, ERNEST LUKE (DO)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:LUKE
Last Name:SQUATRITO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:78 STRICKLAND ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2527
Mailing Address - Country:US
Mailing Address - Phone:860-659-5999
Mailing Address - Fax:860-633-9423
Practice Address - Street 1:131 NEW LONDON TPKE
Practice Address - Street 2:SUITE 103
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4535
Practice Address - Country:US
Practice Address - Phone:860-659-5999
Practice Address - Fax:860-659-5999
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001005364Medicaid
CT001005364Medicaid
CTH03470Medicare UPIN