Healthcare Provider Details

I. General information

NPI: 1962758508
Provider Name (Legal Business Name): EUNICE SAFOAH ASOMANING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 03/29/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 GREEN HOLLOW RD
DANIELSON CT
06239-3509
US

IV. Provider business mailing address

320 POMFRET ST CSB #2
PUTNAM CT
06260-1836
US

V. Phone/Fax

Practice location:
  • Phone: 860-774-1255
  • Fax:
Mailing address:
  • Phone: 860-928-6541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD455685
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: