Provider Information for 1518175173
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Dr. MELISSA SUSAN HENRETTA MD, MPH
Sex: Female
NPI: 1518175173
Last Updated: 2022-07-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1518175173 | ||||||||||||
| Enumeration Date | 2007-05-18 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 231 WESTMONT ST WEST HARTFORD, CT 06117-2935 United States Phone: 614-203-1348 | Fax: | ||||||||||||
| Primary Practice Address | 114 WOODLAND ST HARTFORD, CT 06105-1208 United States Phone: 860-714-4000 | Fax: | ||||||||||||
| Secondary Practice Address(es) | CANCER CTR | ||||||||||||
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