Provider Demographics
NPI:1992784672
Name:MASTROIANNI, LINDA REVAY (MD)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:REVAY
Last Name:MASTROIANNI
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Gender:F
Credentials:MD
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Mailing Address - Street 1:99 EAST RIVER DRIVE
Mailing Address - Street 2:5TH FL
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108
Mailing Address - Country:US
Mailing Address - Phone:860-282-0833
Mailing Address - Fax:860-282-0170
Practice Address - Street 1:80 SEYMOUR STREET
Practice Address - Street 2:JB 333
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102
Practice Address - Country:US
Practice Address - Phone:860-972-1782
Practice Address - Fax:860-545-1784
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-05-05
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Provider Licenses
StateLicense IDTaxonomies
CT027181207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001271816Medicaid
CT001271816Medicaid
D82933Medicare UPIN