Basic Information
| Provider Information | |||||||||
| NPI: | 1033109095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLELLA | ||||||||
| FirstName: | DANETTE | ||||||||
| MiddleName: | T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 ROUTE 108 | ||||||||
| Address2: | |||||||||
| City: | SOMERSWORTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038781522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037492346 | ||||||||
| FaxNumber: | 6039530066 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 ROUTE 108 | ||||||||
| Address2: | |||||||||
| City: | SOMERSWORTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038781522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037492346 | ||||||||
| FaxNumber: | 6039530066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 159758 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 64573 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 19572 | NH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 042297845 | 01 | MA | GREAT WEST HEALTH CARE | OTHER | 100051863 | 05 | WI | MEDICAID | 710585 | 01 | MA | HVD PILGRIM HEALTH CARE | OTHER | 042297845 | 01 | MA | TRICARE | OTHER | 159758 | 01 | MA | TUFTS | OTHER | 042297845 | 01 | MA | PRIVATE HEALTHCARE SYSTEM | OTHER | 0016422 | 01 | MA | NEIGHBORHOOD HLTH PLAN | OTHER | 042297845 | 01 | MA | UNITED HEALTH CARE | OTHER | 042297845 | 01 | MA | GIC UNICARE | OTHER | 3191664 | 05 | MA | MEDICAID | B10361201 | 01 | MA | CIGNA | OTHER | 42310 | 01 | MA | FALLON | OTHER | J19947 | 01 | MA | BCBS | OTHER | 042297845 | 01 | MA | DOC FIRST | OTHER | 7457583 | 01 | MA | AETNA | OTHER | 042297845 | 01 | MA | HCVM | OTHER |