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General NPI Number Information
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NPI Number | 1669669982
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Entity Type | Organization
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Legal Business Name | DARTMOUTH ENDOCRINOLOGY LLC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 44 DALE RD STE 201
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City | AVON
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State | CT
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Zip | 06001-4351
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Country | US
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Telephone | 860-679-0234
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Fax | 860-606-0060
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Provider Business Mailing Address
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Address Line | 44 DALE RD STE 201
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City | AVON
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State | CT
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Zip | 06001-4351
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Country | US
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Telephone | 860-679-0234
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Fax | 860-606-0060
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY J BOMBASSEI
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Credential | MD
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Telephone | 860-679-0234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 032434
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License Number State | CT
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