Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 004355 | CT |
Y | 213EG0000X | General Practice | 004355 | CT |
NPI | 1003931593 |
---|---|
Provider Name | Dr. Bennett Allen Paul |
First Address | Madison, CT 06443 |
Second Address | Madison, CT 06443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |