Healthcare Provider Details

I. General information

NPI: 1225087737
Provider Name (Legal Business Name): BARBARA ANN DEINDORFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 GRINDSTONE HILL RD
NORTH STONINGTON CT
06359-1106
US

IV. Provider business mailing address

334 GRINDSTONE HILL RD
NORTH STONINGTON CT
06359-1106
US

V. Phone/Fax

Practice location:
  • Phone: 860-535-8481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number034519
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: