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General NPI Number Information
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NPI Number | 1114091634
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Entity Type | Organization
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Legal Business Name | CONNECTICUT ORTHOPAEDIC CARE, LLC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25 NEWELL RD
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City | BRISTOL
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State | CT
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Zip | 06010-5100
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Country | US
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Telephone | 860-585-3681
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2828
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City | BRISTOL
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State | CT
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Zip | 06011-2828
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Country | US
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Telephone | 860-585-3681
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Fax |
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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 | 860-585-3681
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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 |
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License Number State |
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