Healthcare Provider Details

I. General information

NPI: 1043239783
Provider Name (Legal Business Name): THOMAS R DEFANTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SWANTOWN HL
NORTH STONINGTON CT
06359-1022
US

IV. Provider business mailing address

75 SWANTOWN HL
NORTH STONINGTON CT
06359-1022
US

V. Phone/Fax

Practice location:
  • Phone: 860-535-1010
  • Fax: 860-445-3677
Mailing address:
  • Phone: 860-535-1010
  • Fax: 860-445-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number011764
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number049233
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: