Individual
DR. THOMAS CLARK BANEVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 RETREAT AVE, SUITE 808, HARTFORD, CT 06106-2528
(860) 249-9189
(860) 249-9180
Mailing address
100 RETREAT AVE, SUITE 808, HARTFORD, CT 06106-2528
(860) 249-9189
(860) 249-9180
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
016245
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00162452
—
CT
Enumeration date
09/12/2005
Last updated
07/08/2007
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