Basic Information
| Provider Information | |||||||||
| NPI: | 1467425371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GHISA | ||||||||
| FirstName: | ADRIANA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PINTEA | ||||||||
| OtherFirstName: | ADRIANA | ||||||||
| OtherMiddleName: | S | ||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1625 STRAITS TPKE | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | MIDDLEBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067621805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035739512 | ||||||||
| FaxNumber: | 2035682904 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | NAUGATUCK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067702836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037296641 | ||||||||
| FaxNumber: | 2037293206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 039570 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001395707 | 05 | CT | MEDICAID |