Provider Demographics
NPI:1659309706
Name:DARDIK, ALAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:DARDIK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AMISTAD ST
Mailing Address - Street 2:ROOM 437
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1637
Mailing Address - Country:US
Mailing Address - Phone:203-737-2082
Mailing Address - Fax:203-737-2290
Practice Address - Street 1:VA CONNECTICUT HEALTHCARE SYSTEMS
Practice Address - Street 2:950 CAMPBELL AVE., BLDG 1, SUITE 4-220
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:203-937-3845
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0394822086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH37963Medicare UPIN