Basic Information
| Provider Information | |||||||||
| NPI: | 1245310432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IANNINI | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068106099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037396959 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 24 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068106099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037396959 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 022392 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110136697 | 01 | CT | RAILROAD MEDICARE | OTHER | 730932 | 01 | CT | CONNECTICARE | OTHER | 010022392CT01 | 01 | CT | ANTHEM BCBS | OTHER | P432502 | 01 | CT | OXFORD HEALTH PLANS | OTHER | 00022392 | 01 | NY | NYS MEDICAID | OTHER | 040197 | 01 | CT | HEALTH NET | OTHER | 472712 | 01 | CT | AETNA US HEALTHCARE | OTHER | 001223924 | 05 | CT | MEDICAID | 0011165 | 01 | CT | CHAMPUS | OTHER | 0095801 | 01 | CT | GHI | OTHER |