1902833379 NPI number — DR. DENNIS L DOBKIN M.D.

Table of content: DR. DENNIS L DOBKIN M.D. (NPI 1902833379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902833379 NPI number — DR. DENNIS L DOBKIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOBKIN
Provider First Name:
DENNIS
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902833379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 CHASE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06708-3352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-573-1435
Provider Business Mailing Address Fax Number:
203-755-7433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 CHASE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-3352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-573-1435
Provider Business Practice Location Address Fax Number:
203-755-7433
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  022917 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207UN0901X , with the licence number: 022917 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001229178 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010022917CT01 . This is a "ANTHEM BC & BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P381467 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 022917 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060039537 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0R0360 . This is a "HEALTH NET OF NORTHEAST" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 25-40429 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1902833379 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4127782 . This is a "AETNA HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 01022917 . This is a "CIGNA HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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