Provider Demographics
NPI:1699890723
Name:PACELLI, PHILIP FLEMMING III (MD DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:FLEMMING
Last Name:PACELLI
Suffix:III
Gender:M
Credentials:MD DMD
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Mailing Address - Street 1:166 CHERRY STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840
Mailing Address - Country:US
Mailing Address - Phone:203-972-1581
Mailing Address - Fax:203-972-1980
Practice Address - Street 1:166 CHERRY STREET
Practice Address - Street 2:SUITE A
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840
Practice Address - Country:US
Practice Address - Phone:203-972-1581
Practice Address - Fax:203-972-1980
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2009-02-13
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Provider Licenses
StateLicense IDTaxonomies
CT007900204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCV2783OtherHEALTH NET
CTP2552103OtherOXFORD
CT020007900CT02OtherANTHEM BCBS
CT190000893Medicare ID - Type Unspecified