Healthcare Provider Details

I. General information

NPI: 1518113984
Provider Name (Legal Business Name): DHAMODARAN PALANIAPPAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2008
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST DEPARTMENT OF ANESTHESIOLOGY, JB 333
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

99 E RIVER DR 5TH FLOOR
EAST HARTFORD CT
06108-3288
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-2117
  • Fax:
Mailing address:
  • Phone: 860-545-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTRN#11326
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number242580
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number050670
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number050670
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: