Provider Demographics
NPI:1427052380
Name:GIACCHETTO, JOHN J (MD PC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:GIACCHETTO
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT026485207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001264853Medicaid
CT030927OtherHEALTHNET
CT200006652OtherRAILROAD MEDICARE
CT0904228OtherUNITED HEALTHCARE
CT797371OtherCONNECTICARE
CT010026485CT03OtherANTHEM BC & BS
CT461209OtherAETNA
CTNLS089OtherOXFORD
CT200006652OtherRAILROAD MEDICARE
CT001264853Medicaid
CT0465450001Medicare NSC