Healthcare Provider Details

I. General information

NPI: 1710989025
Provider Name (Legal Business Name): ROBERT M DODENHOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 KENSINGTON AVE
NEW BRITAIN CT
06051-3916
US

IV. Provider business mailing address

300 KENSINGTON AVE
NEW BRITAIN CT
06051-3916
US

V. Phone/Fax

Practice location:
  • Phone: 860-832-8150
  • Fax: 860-224-6298
Mailing address:
  • Phone: 860-832-8150
  • Fax: 860-224-6298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number028303
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: