Healthcare Provider Details

I. General information

NPI: 1861491839
Provider Name (Legal Business Name): TAPAS BANDYOPADHYAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 S MAIN ST
WEST HARTFORD CT
06107-2486
US

IV. Provider business mailing address

30 JORDAN LN
WETHERSFIELD CT
06109-1278
US

V. Phone/Fax

Practice location:
  • Phone: 860-247-2530
  • Fax:
Mailing address:
  • Phone: 860-263-0253
  • Fax: 860-263-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number035622
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number035622
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: