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General NPI Number Information
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NPI Number | 1033548029
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Entity Type | Organization
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Legal Business Name | VIPUL DUA, MD, LLC
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Dates
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Enumeration Date | 11/11/2013
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Last Update Date | 11/11/2013
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Provider Practice Location Address
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Address Line | 2800 TAMARACK AVE SUITE 106
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-5539
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Country | US
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Telephone | 860-644-5900
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Fax | 860-644-5978
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Provider Business Mailing Address
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Address Line | 2800 TAMARACK AVE SUITE 106
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-5539
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Country | US
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Telephone | 860-644-5900
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Fax | 860-644-5978
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Authorized Official
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Title or Position | OWNER
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Name | VIPUL DUA
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Credential | MD
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Telephone | 860-644-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 041795
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License Number State | CT
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