Healthcare Provider Details

I. General information

NPI: 1588848774
Provider Name (Legal Business Name): KRISTOFER BAGDASARIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE SUITE 2120
HARTFORD CT
06105-1770
US

IV. Provider business mailing address

1000 ASYLUM AVE SUITE 2120
HARTFORD CT
06105-1770
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-4000
  • Fax: 860-527-6985
Mailing address:
  • Phone: 860-246-4000
  • Fax: 860-527-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number050825
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number50825
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: