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Individual

DR. ELENA BORTAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
100 PERKINS FARM DRIVE, SUITE 102, MYSTIC, CT 06355
(860) 870-6385
(860) 245-0000
Mailing address
100 PERKINS FARM DRIVE, SUITE 102, MYSTIC, CT 06355
(201) 724-4434

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
048689
CT
174400000X
Specialist
235541
MA
2084N0400X
Neurology Physician
Primary
048689
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
224972
LIMITED LICENSE
MA
Enumeration date
05/19/2007
Last updated
07/19/2022
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