Healthcare Provider Details

I. General information

NPI: 1164587564
Provider Name (Legal Business Name): BIJAY MUKHOPADHYAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOHN DEMPSEY HOSPITAL 263 FARMINGTON AVENUE, MC-3210
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

JOHN DEMPSEY HOSPITAL 263 FARMINGTON AVENUE, MC-3210
FARMINGTON CT
06030-0001
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4236
  • Fax:
Mailing address:
  • Phone: 860-679-4236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number021914
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: