Healthcare Provider Details

I. General information

NPI: 1780824581
Provider Name (Legal Business Name): LEAH W BASSIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 FARMINGTON AVE SUITE 200
FARMINGTON CT
06032-1936
US

IV. Provider business mailing address

399 FARMINGTON AVE SUITE 200
FARMINGTON CT
06032-1936
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-2071
  • Fax: 860-284-0080
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number054250
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberCSP0044205
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: