Organization
MARK D. DEPONTE, M.D.,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK D DEPONTE M.D. (OWNER)
(860) 376-4451
Entity
Organization
Contact information
Practice address
2 LEE RD, LISBON, CT 06351-3015
(860) 376-4451
(860) 376-5977
Mailing address
2 LEE RD, LISBON, CT 06351-3015
(860) 376-4451
(860) 376-5977
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
39445
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001399452
—
CT
01
—
010039945CT01
BLUE CROSS
CT
01
—
2V1508
HEALTHNET
CT
01
—
780555
CONNECTICARE
CT
Enumeration date
01/14/2010
Last updated
01/14/2010
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