Provider Demographics
NPI:1902833379
Name:DOBKIN, DENNIS L (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:DOBKIN
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 1:455 CHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3352
Mailing Address - Country:US
Mailing Address - Phone:203-573-1435
Mailing Address - Fax:203-755-7433
Practice Address - Street 1:455 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3352
Practice Address - Country:US
Practice Address - Phone:203-573-1435
Practice Address - Fax:203-755-7433
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022917207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001229178Medicaid
CT010022917CT01OtherANTHEM BC & BS
CTP381467OtherOXFORD HEALTH PLANS
CT022917OtherCONNECTICARE
CT060039537OtherRAILROAD MEDICARE
CT0R0360OtherHEALTH NET OF NORTHEAST
CT25-40429OtherUNITED HEALTHCARE
CT1902833379Medicaid
CT4127782OtherAETNA HEALTH PLANS
CT01022917OtherCIGNA HEALTH PLANS
CTD400039781Medicare PIN
CTP381467OtherOXFORD HEALTH PLANS
CT060000158Medicare PIN