Provider Demographics
NPI:1639557408
Name:BEGASSE DE DHAEM, OLIVIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:BEGASSE DE DHAEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SUB WAY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1000
Mailing Address - Country:US
Mailing Address - Phone:860-696-2925
Mailing Address - Fax:860-696-2926
Practice Address - Street 1:29 HOSPITAL PLZ STE 602
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2778152084N0400X
CT649192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology