Healthcare Provider Details

I. General information

NPI: 1083078257
Provider Name (Legal Business Name): AMY BLODGETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 FLANDERS RD
EAST LYME CT
06333-1743
US

IV. Provider business mailing address

305 FLANDERS RD
EAST LYME CT
06333-1743
US

V. Phone/Fax

Practice location:
  • Phone: 860-739-0348
  • Fax:
Mailing address:
  • Phone: 860-739-0348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64290
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: