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NPI Code Detail

MEDICARE: DR. BRYAN VINCENT BOFFI M.D.

MEDICARE: DR. BRYAN VINCENT BOFFI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician029834CT

General Provider Information

NPI Number : 1679584320
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRYAN VINCENT BOFFI M.D.
Provider Business Mailing Address
First Line : 4 DEVONSHIRE CT
Second Line :
City : AVON
State : CT
Zip : 06001-2448
Country : US
Telephone Number : 860-404-0068
Fax Number : 860-496-3868
Provider Business Practice Location Address
First Line : 249 WINSTED RD
Second Line :
City : TORRINGTON
State : CT
Zip : 06790-2958
Country : US
Telephone Number : 860-496-3713
Fax Number : 860-496-3868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 07/08/2007

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