Provider Demographics
NPI:1639154628
Name:DHAMI, MANDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:
Last Name:DHAMI
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 1:330 WASHINGTON ST STE 220
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2700
Mailing Address - Country:US
Mailing Address - Phone:860-912-2147
Mailing Address - Fax:860-886-9262
Practice Address - Street 1:330 WASHINGTON ST STE 220
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2700
Practice Address - Country:US
Practice Address - Phone:860-886-8362
Practice Address - Fax:860-886-9262
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-09-16
Deactivation Date:2021-03-15
Deactivation Code:
Reactivation Date:2021-04-12
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0616207RH0003X
CT29948207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001299488Medicaid
CT010029948CT01OtherBCBS
CT2358910OtherAETNA
F34316Medicare UPIN
CT001299488Medicaid