MR. LEO JOSEPH DISTEFANO MD NPI 1760453724

NPI Information

NPI: 1760453724
Provider Name: MR. LEO JOSEPH DISTEFANO, MD
Classification: Pediatrics - 2080A0000X
Entity Type: Individual

Specialization: Adolescent Medicine

Address:
970 FARMINGTON AVENUE
SUITE 201
WEST HARTFORD, CT
ZIP 06107
Phone: (860) 561-4300
Get Directions

MR. Leo Joseph Distefano, MD is an adolescent medicine pediatrics in West Hartford, CT. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. MR. Leo Joseph Distefano, MD NPI is 1760453724. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

970 FARMINGTON AVENUE
SUITE 201
WEST HARTFORD, CT
ZIP 06107
Phone: (860) 561-4300
Fax: (860) 561-1635

The enumeration date for this NPI number is 1/30/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine	033656	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	735010	OTHER	CONNECTICUT	CONNECTICARE
2	00133656100	MEDICAID	CONNECTICUT
3	01003365CT01	OTHER	CONNECTICUT	ANTHEM BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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