Healthcare Provider Details

I. General information

NPI: 1942227913
Provider Name (Legal Business Name): HARPREET S. BAWEJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 200
HARTFORD CT
06106-5509
US

IV. Provider business mailing address

111 FOUNDERS PLZ STE 400
EAST HARTFORD CT
06108-3240
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-6589
  • Fax:
Mailing address:
  • Phone: 860-289-3375
  • Fax: 860-783-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number046407
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number246268
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: