Provider Demographics
NPI:1588917918
Name:ORAZIETTI, KATHLEEN MARY (PA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:ORAZIETTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 BRIDGEPORT AVENUE
Mailing Address - Street 2:C/O ROBERT D. RUSSO, MD & ASSOCIATES RADIOLOGY, PC
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484
Mailing Address - Country:US
Mailing Address - Phone:203-683-4683
Mailing Address - Fax:203-926-1415
Practice Address - Street 1:2660 MAIN STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-683-4540
Practice Address - Fax:203-926-1410
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology