Diane D'Isidori, M.D.

Key facts

NPI

1710434840

Entity type

Individual (NPI type 1)

Primary specialty

Pediatrics Physician 208000000X

License

029150 (CT)

Practice address

120 Park Lane Rd
Suite A101
New Milford, CT 06776-2444

Phone

(860) 355-8190

Fax

(860) 355-3856

NPI assigned

Sep 7, 2016

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Candlewood Valley Pediatrics, P.C. Pediatrics Physician · New Milford, CT · NPI 1811021066
  NPD (past) PEDIATRICS

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Medicine

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 7, 2016.

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473206400000",
    "number": "1710434840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 PUTNAM RD",
            "city": "NEW MILFORD",
            "state": "CT",
            "postal_code": "067765332",
            "telephone_number": "203-788-5538",
            "fax_number": "860-355-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 PARK LANE RD",
            "address_2": "SUITE A101",
            "city": "NEW MILFORD",
            "state": "CT",
            "postal_code": "067762444",
            "telephone_number": "860-355-8190",
            "fax_number": "860-355-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'ISIDORI",
        "first_name": "DIANE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2016-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "029150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in New Milford, CT · Pediatrics Physician in Connecticut