Provider Demographics
NPI:1003813965
Name:KOBYLARZ, DENNIS J (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:KOBYLARZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-0970
Mailing Address - Country:US
Mailing Address - Phone:860-824-0753
Mailing Address - Fax:860-824-4448
Practice Address - Street 1:10 GRANITE AVE.
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-0970
Practice Address - Country:US
Practice Address - Phone:860-824-0753
Practice Address - Fax:860-824-4448
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT027736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA054714OtherTUFTS
MA3003621Medicaid
P3296700OtherOXFORD
MA000000026702OtherBMC HEALTHNET
CT001277367Medicaid
CT010017975OtherRAILROAD MEDICARE
NY081142OtherMVP
CT2V5878OtherHEALTHNET
0119144OtherEVERCARE
MA13644OtherHEALTH NEW ENGLAND
MAA21057OtherMEDICARE MA
MAA67899OtherHARVARD
CT010027736CT01OtherBLUE CROSS BLUE SHIEL CT
CT080001602OtherMEDICARE CT
366275OtherAETNA
CT779997OtherCONNECTICARE
MARO1115OtherBLUE CROSS BLUE SHIELD MA
NY5996764OtherGHI
CT001277367Medicaid
MA3003621Medicaid