Provider Demographics
NPI:1235429697
Name:DI PASQUALE, DORALYNNE ROSE (DO)
Entity type:Individual
Prefix:
First Name:DORALYNNE
Middle Name:ROSE
Last Name:DI PASQUALE
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2805
Mailing Address - Country:US
Mailing Address - Phone:203-384-4677
Mailing Address - Fax:203-384-3135
Practice Address - Street 1:320 WESTERN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1276
Practice Address - Country:US
Practice Address - Phone:860-657-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51722207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine