MEDICARE: DR. AMAL DAS 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	207VG0400X	Gynecology Physician	017289	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710099288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMAL DAS MD

Provider Business Mailing Address
First Line	:	580 COTTAGE GROVE RD STE 104
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3088
Country	:	US
Telephone Number	:	860-242-0774
Fax Number	:	860-242-7444

Provider Business Practice Location Address
First Line	:	580 COTTAGE GROVE RD STE 104
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3088
Country	:	US
Telephone Number	:	860-242-0774
Fax Number	:	860-242-7444

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/24/2026

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