Basic Information
| Provider Information | |||||||||
| NPI: | 1295715654 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SISTO | ||||||||
| FirstName: | DONATO | ||||||||
| MiddleName: | ANTONIO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., FACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 BORTHWICK AVE | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038017128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035594111 | ||||||||
| FaxNumber: | 6035594110 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068106077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037397000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 10477 | NH | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 042-0014571 | VT | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 66653 | CT | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 3086754 | 05 | NH | MEDICAID |