Provider Demographics
NPI:1235143603
Name:PALLUOTTO, ERIC CARL (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CARL
Last Name:PALLUOTTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-562-9939
Mailing Address - Fax:203-782-2476
Practice Address - Street 1:1488 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-562-9939
Practice Address - Fax:203-782-2476
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT24728207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT160000464Medicare ID - Type Unspecified
B84591Medicare UPIN
CTD400000834Medicare PIN