Provider Demographics
NPI:1548247026
Name:MIGLIORATO, MARCIE A (MD)
Entity type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:A
Last Name:MIGLIORATO
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:336 NORTH MAIN STREET
Mailing Address - Street 2:HARTFORD MEDICAL GROUP
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117
Mailing Address - Country:US
Mailing Address - Phone:860-232-4891
Mailing Address - Fax:860-236-1016
Practice Address - Street 1:336 NORTH MAIN STREET
Practice Address - Street 2:HARTFORD MEDICAL GROUP
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117
Practice Address - Country:US
Practice Address - Phone:860-232-4891
Practice Address - Fax:860-236-1016
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT032290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001322908Medicaid
CT110004548Medicare PIN
F35999Medicare UPIN
110206672Medicare PIN