DR. MARCELLO MICHAEL DISTASIO JR. (NPI# 1609295781) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609295781 |
| Entity Type | Individual |
| Full Name | DR. MARCELLO MICHAEL DISTASIO JR. |
| Credential | M.D., PH.D. |
| Practice Address |
310 Cedar St New Haven CT 06510-3218 |
| Mailing Address |
75 Francis St Boston MA 02115-6110 |
| Practice Telephone | 2037853624 |
| Mailing Telephone | 6177327510 |
| Mailing Fax Number | 6172779015 |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2020-11-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZN0500X |
Pathology Specialization: Neuropathology |
64362 | CT | Allopathic & Osteopathic Physicians |
| N | 207ZP0101X |
Pathology Specialization: Anatomic Pathology |
64362 | CT | Allopathic & Osteopathic Physicians |
| Street Address |
310 CEDAR ST |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06510-3218 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033117841 | Raffaella Morotti | Pathology | 310 Cedar St, Pathology Department, New Haven, CT 06510-3218 | 2005-07-14 |
| 1194245100 | Jeff Wang | Student in an Organized Health Care Education/Training Program | 310 Cedar St, New Haven, CT 06510-3218 | 2017-06-21 |
| 1851824833 | Edwin Partovi | Pathology | 310 Cedar St, Yusm, Department of Pathology, New Haven, CT 06510-3218 | 2017-04-06 |
| 1568811594 | Hatem Osama Kaseb | Student in an Organized Health Care Education/Training Program | 310 Cedar St, Yusm, Department of Pathology, New Haven, CT 06510-3218 | 2016-06-09 |
| 1689022352 | Benjamin Louis Mazer | Student in an Organized Health Care Education/Training Program | 310 Cedar St, Yusm, Department of Pathology, New Haven, CT 06510-3218 | 2016-06-02 |
| 1255788360 | Omeed Hafez | Student in an Organized Health Care Education/Training Program | 310 Cedar St, Yusm, Department of Pathology, New Haven, CT 06510-3218 | 2016-05-18 |
| 1326494881 | Douglas Rottmann | Student in an Organized Health Care Education/Training Program | 310 Cedar St, Yusm, Department of Pathology, New Haven, CT 06510-3218 | 2016-05-13 |
| 1831545466 | Deepika Kumar | Student in an Organized Health Care Education/Training Program | 310 Cedar St, Yusm, Department of Pathology, New Haven, CT 06510-3218 | 2016-05-12 |
| 1598145120 | Mohammadreza Shervinrad | Student in an Organized Health Care Education/Training Program | 310 Cedar St, Yusm, Department of Pathology, New Haven, CT 06510-3218 | 2015-06-09 |
| 1548648421 | Kevin Timothy Pelland Jr. | Student in an Organized Health Care Education/Training Program | 310 Cedar St, Yusm, Department of Pathology, New Haven, CT 06510-3218 | 2015-05-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336757319 | Matthew Peter O'connell | Pharmacist | 55 Park Street, Lower Level, Department of Pharmacy, New Haven, CT 06510 | 2020-07-16 |
| 1477171460 | Huy Henry Le | Pharmacist | 20 York Street, Ps-ll, New Haven, CT 06510 | 2020-07-07 |
| 1144855263 | Daniel Jacobs | Student in an Organized Health Care Education/Training Program | 367 Cedar Street, Bldg. D, Student Affairs Office, New Haven, CT 06510 | 2020-03-09 |
| 1346898467 | Cem Cengiz | Internal Medicine | Tobb Etu Hastanesi, Yasam Cad. No.5 Sogutozu, Ankara, TURKEY 06510 | 2019-09-02 |
| 1295292290 | Emily Elizabeth Samuel | Counselor | 40 Temple Street, Ste 7c, Yale Child Outpatient Clinic, New Haven, CT 06510 | 2019-02-26 |
| 1639652779 | Laura Goldblum | Social Worker | 1450 Chapel Childrens Hospital, 1450 Chapel Street, New Haven, CT 06510 | 2018-09-14 |
| 1477049138 | Joseph Lawrence Earles | Otolaryngology | Yale Physicians Building, 800 Howard Ave., 4th Floor, New Haven, CT 06510 | 2018-07-06 |
| 1508356759 | Rebecca Anne Beagan | Student in an Organized Health Care Education/Training Program | 20 York Street- Pediatrics, New Haven, CT 06510 | 2018-05-14 |
| 1104316405 | Emma Sophie Taylor-salmon | Student in an Organized Health Care Education/Training Program | 20 York Street - Pediatrics, New Haven, CT 06510 | 2018-05-14 |
| 1376033563 | Wael S Ibrahim | Student in an Organized Health Care Education/Training Program | 20 York Street, Ynnh - Tompkins 226, New Haven, CT 06510 | 2018-05-14 |
| Find all providers in zip 06510 | ||||
| Taxonomy Code | 207ZN0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Neuropathology |
| A neuropathologist is expert in the diagnosis of diseases of the nervous system and skeletal muscles and functions as a consultant primarily to neurologists and neurosurgeons. The neuropathologist is knowledgeable in the infirmities of humans as they affect the nervous and neuromuscular systems, be they degenerative, infectious, metabolic, immunologic, neoplastic, vascular or physical in nature. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. American Osteopathic Board of Pathology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pathology. The Certification is NO longer provided. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972885010 | Declan Mcguone | Pathology | Yale Pathology, 20 York Street, Ep2-631, New Haven, CT 06510 | 2011-09-14 |
| 1316171762 | Pallavi Padmapriya Gopal | Pathology | 20 York St # Ep2-631, New Haven, CT 06510-3220 | 2009-05-13 |
| 1124265665 | Alexander Vortmeyer | Pathology | 310 Cedar St, 416a Lauder Hall, New Haven, CT 06510-3218 | 2009-01-20 |
| 1518956937 | Jung H Kim | Pathology | 310 Cedar St, Lauder Hall Rm 108, New Haven, CT 06510-3218 | 2005-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902002249 | Xianyuan Song | Pathology | 80 Seymour Street, Hartford, CT 06102-5037 | 2007-06-25 |
| 1336131861 | Qian Wu | Pathology | 263 Farmington Ave, Farmington, CT 06030-0001 | 2005-08-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.