Healthcare Provider Details

I. General information

NPI: 1407062417
Provider Name (Legal Business Name): DYANNE M TAPPIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DYANNE PHILLIPPE

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-8031
US

IV. Provider business mailing address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-8031
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-7687
  • Fax: 860-679-0131
Mailing address:
  • Phone: 860-679-7687
  • Fax: 860-679-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number243899
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number075924
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: