Provider Demographics
NPI:1710989025
Name:DODENHOFF, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:DODENHOFF
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 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-832-8150
Mailing Address - Fax:860-224-6298
Practice Address - Street 1:300 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3916
Practice Address - Country:US
Practice Address - Phone:860-832-8150
Practice Address - Fax:860-224-6298
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010028303CT01OtherBCBS PROVIDER ID
CT004215324Medicaid
CT02830301OtherCONNECTICARE ID
CT477150OtherAENTA PROVIDER ID REF
CT912613OtherHEALTH NET REF ID
CT01028303OtherCIGNA PROVIDER ID
CTP369832OtherOXFORD PROVIDER ID
CT001283035Medicaid
CT060080OtherHEALTH NET PROVIDER ID
CT1255448155OtherGHMC GRP NPI ID
CT010028303CT01OtherBCFP PROVIDER ID
CT477150OtherAENTA PROVIDER ID REF
CT1255448155OtherGHMC GRP NPI ID
D83597Medicare UPIN