Healthcare Provider Details

I. General information

NPI: 1932895372
Provider Name (Legal Business Name): NICOLE ALYSSA BAMBARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 JEFFERSON ST
HARTFORD CT
06106
US

IV. Provider business mailing address

95 WOODLAND ST FL 1
HARTFORD CT
06105-1230
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-0200
  • Fax: 860-545-3149
Mailing address:
  • Phone: 860-714-7362
  • Fax: 860-714-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number84654
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: