Basic Information
| Provider Information | |||||||||
| NPI: | 1417147406 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VISCHIO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 195 EASTERN BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060331208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602464260 | ||||||||
| FaxNumber: | 8604309770 | ||||||||
| Practice Location | |||||||||
| Address1: | 195 EASTERN BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GLASTONBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060331208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602464260 | ||||||||
| FaxNumber: | 8604309770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 03/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 067435 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 004167707 | 05 | CT | MEDICAID |