Healthcare Provider Details

I. General information

NPI: 1578762241
Provider Name (Legal Business Name): SMITA BHAGAT M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 HAZARD AVE BLDG 3, UNIT 10
ENFIELD CT
06082-4585
US

IV. Provider business mailing address

139 HAZARD AVE BLDG 3, UNIT 10
ENFIELD CT
06082-4585
US

V. Phone/Fax

Practice location:
  • Phone: 860-763-4337
  • Fax: 860-763-6458
Mailing address:
  • Phone: 860-763-4337
  • Fax: 860-763-6458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SMITA BHAGAT
Title or Position: MD
Credential: MD
Phone: 860-763-4337