Mr. Leo Joseph Distefano Iii
MD | Pediatric Adolescent Medicine | Male
Mr. Leo Joseph Distefano Iii, MD is a West Hartford, Connecticut based Pediatric doctor with medical specialization in
Pediatric Adolescent Medicine.
Current practice location of Mr. Leo Joseph Distefano Iii is
970 Farmington Avenue, Suite 201, West Hartford, Connecticut - 06107. He can be contacted on phone at
860-561-4300 and fax number 860-561-1635.
Mr. Leo Joseph Distefano Iii is a sole proprietor of his business.
NPI number (Unique professional ID) for Mr. Leo Joseph Distefano Iii is
1760453724 which was assigned by NPPES on 30 Jan, 2006 and it was last updated on 08 Jul, 2007.
Mr. Leo Joseph Distefano Iii license number is
033656 for Pediatrics Adolescent Medicine (2080A0000X) in Connecticut.
Mr. Leo Joseph Distefano Iii specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Complete Profile:
Mr. Leo Joseph Distefano Iii basic information including his official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics Adolescent Medicine |
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| Provider Name : | Mr. Leo Joseph Distefano Iii |
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| Credential : | MD |
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| Gender : | Male |
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Business Address:
Mr. Leo Joseph Distefano Iii address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 970 Farmington Avenue, Suite 201
West Hartford, CT, 06107
United States |
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| Phone Number : | 860-561-4300 |
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| Fax Number : | 860-561-1635 |
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Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1760453724 |
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| NPI Entity Type : | Individual |
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| First Enrolment Date : | 30 Jan, 2006 |
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| Last Updated On : | 08 Jul, 2007 |
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Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Mr. Leo Joseph Distefano Iii are as mentioned. Primary taxonomy code for Mr. Leo Joseph Distefano Iii, MD is
2080A0000X (Pediatrics Adolescent Medicine).
| Taxonomy Code | Speciality | Primary | License No. | State |
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| 2080A0000X | Pediatrics Adolescent Medicine | Yes | 033656 | CT |
Legacy Identifiers:
Other legacy medical identifiers of Mr. Leo Joseph Distefano Iii such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
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| 00133656100 | MEDICAID | CT | |
| 01003365CT01 | Other | CT | ANTHEM BCBS |
| 735010 | Other | CT | CONNECTICARE |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | 970 Farmington Avenue, Suite 201
West Hartford, CT, 06107
United States |
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| Phone Number : | 860-561-4300 |
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| Fax Number : | 860-561-1635 |
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Business Location:
Patients can refer following map for directions to
Mr. Leo Joseph Distefano Iii practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES.