Individual
MARK DAVID DEPONTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 LEE RD, LISBON, CT 06351
(860) 376-4451
(860) 376-5977
Mailing address
2 LEE RD, LISBON, CT 06351
(860) 376-4451
(860) 376-5977
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
039945
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001399452
—
CT
01
—
010039945CT01
BCBS
—
01
—
020323907
CIGNA
—
01
—
2V1508
HEALTHNET
—
Enumeration date
06/01/2005
Last updated
11/19/2009
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