Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 050190 | CT |
N | 2080P0208X | Pediatric Infectious Diseases | 050190 | CT |
NPI | 1588826309 |
---|---|
Provider Name | Dr. Nicholas John Bennett |
First Address | Hartford, CT 06106-3322 |
Second Address | Hartford, CT 06106-3322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 01/10/2013 |