Healthcare Provider Details

I. General information

NPI: 1720491384
Provider Name (Legal Business Name): PETER PAUL VLISMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 320
HARTFORD CT
06106-5502
US

IV. Provider business mailing address

85 JEFFERSON ST
HARTFORD CT
06106-2601
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-4219
  • Fax:
Mailing address:
  • Phone: 860-972-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number70840
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number070840
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: