Provider Demographics
NPI:1467488510
Name:MAKKAR, HANSPAUL S (MD)
Entity Type:Individual
Prefix:
First Name:HANSPAUL
Middle Name:S
Last Name:MAKKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILLOWBROOK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1745
Mailing Address - Country:US
Mailing Address - Phone:860-322-2222
Mailing Address - Fax:860-322-6838
Practice Address - Street 1:1 WILLOWBROOK RD STE 2
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1745
Practice Address - Country:US
Practice Address - Phone:860-322-2222
Practice Address - Fax:860-322-6838
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044189207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1441899Medicaid
CT070000516Medicare PIN
CTI51956Medicare UPIN