Provider Information for 1194775965
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Dr. THOMAS PAUL AGRESTA M.D.
Sex: Male
NPI: 1194775965
Last Updated: 2021-07-01
Certification Date: 2021-07-01
Certification Date: 2021-07-01
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1194775965 | ||||||||||||||
| Enumeration Date | 2006-05-11 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 99 WOODLAND ST HARTFORD, CT 06105-1207 United States Phone: 860-714-4212 | Fax:860-714-8080 | ||||||||||||||
| Primary Practice Address | 99 WOODLAND ST HARTFORD, CT 06105-1207 United States Phone: 860-714-4212 | Fax:860-714-8080 | ||||||||||||||
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