Organization
AVANTA CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUDEEP BANSAL MD (OWNER)
(860) 430-5599
Entity
Organization
Contact information
Practice address
131 NEW LONDON TPKE STE 105, GLASTONBURY, CT 06033
(860) 430-5599
Mailing address
131 NEW LONDON TPKE STE 105, GLASTONBURY, CT 06033-2246
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
05/14/2018
Last updated
05/04/2026
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