Provider Demographics
NPI:1215233044
Name:PASCUCCI, KATHRYN (DO)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:PASCUCCI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 SULLIVAN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2754
Mailing Address - Country:US
Mailing Address - Phone:860-644-6676
Mailing Address - Fax:860-648-9501
Practice Address - Street 1:1340 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2754
Practice Address - Country:US
Practice Address - Phone:860-644-6676
Practice Address - Fax:860-648-9501
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050725207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050725OtherCT STATE LICENSE