Basic Information
| Provider Information | |||||||||
| NPI: | 1952561821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONTI | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 LAFAYETTE ST | ||||||||
| Address2: | |||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604253805 | ||||||||
| FaxNumber: | 8604258707 | ||||||||
| Practice Location | |||||||||
| Address1: | 82 NORWICH WESTERLY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH STONINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063591744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605999961 | ||||||||
| FaxNumber: | 8605999967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2008 | ||||||||
| LastUpdateDate: | 05/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 243563 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 243563 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 050102 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.