Provider Demographics
NPI:1427060045
Name:PECCERILLO, JOSEPH A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:PECCERILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CENTER ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4100
Mailing Address - Country:US
Mailing Address - Phone:203-284-1060
Mailing Address - Fax:203-284-4981
Practice Address - Street 1:185 CENTER ST
Practice Address - Street 2:SUITE H
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4100
Practice Address - Country:US
Practice Address - Phone:203-284-1060
Practice Address - Fax:203-284-4981
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035291207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00135291Medicaid
CT00135291Medicaid
CT160001429Medicare ID - Type Unspecified