Provider Demographics
NPI:1710015839
Name:BRISTOL UROLOGIC ASSOCIATES PC
Entity Type:Organization
Organization Name:BRISTOL UROLOGIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DADDARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-585-6944
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:8 COLLINS RD
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:860-585-6944
Mailing Address - Fax:860-585-7746
Practice Address - Street 1:8 COLLINS RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-585-6944
Practice Address - Fax:860-585-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty