Provider Demographics
NPI:1023083193
Name:HOFBAUER, HENRY BEAR (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:BEAR
Last Name:HOFBAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:850 N MAIN STREET EXT
Mailing Address - Street 2:BUILDING 2, SUITE C3
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2400
Mailing Address - Country:US
Mailing Address - Phone:203-265-6522
Mailing Address - Fax:203-265-5605
Practice Address - Street 1:850 N MAIN STREET EXT
Practice Address - Street 2:BUILDING 2, SUITE C3
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2400
Practice Address - Country:US
Practice Address - Phone:203-265-6522
Practice Address - Fax:203-265-5605
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83400Medicare UPIN
110000638Medicare ID - Type Unspecified