Provider Demographics
NPI:1205883790
Name:MISRA, BISMRUTA (MD)
Entity type:Individual
Prefix:
First Name:BISMRUTA
Middle Name:
Last Name:MISRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 LONG RIDGE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1627
Mailing Address - Country:US
Mailing Address - Phone:203-276-7213
Mailing Address - Fax:203-276-4975
Practice Address - Street 1:292 LONG RIDGE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1627
Practice Address - Country:US
Practice Address - Phone:203-276-7213
Practice Address - Fax:203-276-4975
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047686207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
I40727Medicare UPIN