MEDICARE: AMANDA DINSMORE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	66679	CT

General Provider Information

NPI Number	:	1578806758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA DINSMORE MD

Provider Business Mailing Address
First Line	:	57 NORTH ST STE 415
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5629
Country	:	US
Telephone Number	:	203-794-0117
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 NORTH ST STE 415
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5629
Country	:	US
Telephone Number	:	203-794-0117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	09/14/2022

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