Healthcare Provider Details

I. General information

NPI: 1467488510
Provider Name (Legal Business Name): HANSPAUL S MAKKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILLOWBROOK RD STE 2
CROMWELL CT
06416-1745
US

IV. Provider business mailing address

1 WILLOWBROOK RD STE 2
CROMWELL CT
06416-1745
US

V. Phone/Fax

Practice location:
  • Phone: 860-322-2222
  • Fax: 860-322-6838
Mailing address:
  • Phone: 860-322-2222
  • Fax: 860-322-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number044189
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number044189
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number044189
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: