Healthcare Provider Details

I. General information

NPI: 1497750152
Provider Name (Legal Business Name): TODD M BISHOP DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SOUTH MAIN ST
MIDDLETOWN CT
06457
US

IV. Provider business mailing address

80 SOUTH MAIN ST
MIDDLETOWN CT
06457
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-6878
  • Fax:
Mailing address:
  • Phone: 860-358-6878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number043002
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number229835
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number229835
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: