Healthcare Provider Details

I. General information

NPI: 1528017159
Provider Name (Legal Business Name): BRISTOL HOSPITAL CLINICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BREWSTER RD
BRISTOL CT
06010-5142
US

IV. Provider business mailing address

PO BOX 2828
BRISTOL CT
06011-2828
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-3000
  • Fax: 860-585-3907
Mailing address:
  • Phone: 860-585-3906
  • Fax: 860-585-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LEONARD BANCO
Title or Position: VICE PRESIDENT
Credential:
Phone: 860-585-3906