Provider Demographics
NPI:1720491384
Name:VLISMAS, PETER PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:PAUL
Last Name:VLISMAS
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 1:85 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2601
Mailing Address - Country:US
Mailing Address - Phone:860-972-1212
Mailing Address - Fax:
Practice Address - Street 1:85 SEYMOUR ST STE 320
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5502
Practice Address - Country:US
Practice Address - Phone:860-972-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70840207RC0000X
CT070840207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease