Pannullo, Ava M

Pannullo, Ava M is an individual health care provider with primary practice located at 1 Abrahms Blvd , West Hartford CT 06117-3949. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is her primary health care specialty. Pannullo, Ava M can be contacted via phone (860) 523-3800.

Contact Information

Primary practice address
1 Abrahms Blvd West Hartford CT 06117-3949
Phone: (860) 523-3800
Fax: (860) 523-3949
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X 031669 Connecticut
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 31669 Connecticut

Profile Details

NPI number 1578545620
LBN Legal business name Pannullo, Ava M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2005
Last updated Jun 26th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578545620 NPPES
Connecticut Other 010031669CT01 BC
Connecticut MEDICAID 001316696 BC

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