Provider Demographics
NPI:1710099288
Name:DAS, AMAL (MD)
Entity Type:Individual
Prefix:
First Name:AMAL
Middle Name:
Last Name:DAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 COTTAGE GROVE RD
Mailing Address - Street 2:STE 206
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3088
Mailing Address - Country:US
Mailing Address - Phone:860-242-0774
Mailing Address - Fax:860-242-7444
Practice Address - Street 1:580 COTTAGE GROVE RD
Practice Address - Street 2:STE 206
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3088
Practice Address - Country:US
Practice Address - Phone:860-242-0774
Practice Address - Fax:860-242-7444
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT017289207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1172899Medicaid
CT1172899Medicaid
160000342Medicare ID - Type Unspecified