1194945063 NPI number — ALINA ILEANA DOBRITA M.D.

Table of content: ALINA ILEANA DOBRITA M.D. (NPI 1194945063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194945063 NPI number — ALINA ILEANA DOBRITA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOBRITA
Provider First Name:
ALINA
Provider Middle Name:
ILEANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BALLY
Provider Other First Name:
ALINA
Provider Other Middle Name:
ILEANA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194945063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 W AVON RD
Provider Second Line Business Mailing Address:
STE 301
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06001-3679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-404-2905
Provider Business Mailing Address Fax Number:
860-470-3198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 W AVON RD
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06001-3679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-404-2905
Provider Business Practice Location Address Fax Number:
860-470-3198
Provider Enumeration Date:
04/26/2007

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: 207Q00000X , with the licence number:  045219 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1194945063 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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