Provider Demographics
NPI:1366436594
Name:SARACCO, JOSEPH ANTHONY III (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:SARACCO
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4312
Mailing Address - Country:US
Mailing Address - Phone:203-933-8606
Mailing Address - Fax:
Practice Address - Street 1:385 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4312
Practice Address - Country:US
Practice Address - Phone:203-933-8606
Practice Address - Fax:203-932-9571
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004188349Medicaid
CT004188349Medicaid
CT480000755Medicare PIN