Healthcare Provider Details

I. General information

NPI: 1912904244
Provider Name (Legal Business Name): THOMAS W DUGDALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SEYMOUR ST FL 2
HARTFORD CT
06106-5521
US

IV. Provider business mailing address

31 SEYMOUR STREET HARTFORD HOSPITAL ORTHOPEDICS DEPT
HARTFORD CT
06106-5521
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-0050
  • Fax:
Mailing address:
  • Phone: 860-972-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number024709
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: