Provider Demographics
NPI:1841562824
Name:BOMAR, C DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:C DAVID
Middle Name:
Last Name:BOMAR
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 1:232 MAXINE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-2356
Mailing Address - Country:US
Mailing Address - Phone:860-940-9992
Mailing Address - Fax:860-584-2495
Practice Address - Street 1:232 MAXINE RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-2356
Practice Address - Country:US
Practice Address - Phone:860-940-9992
Practice Address - Fax:860-584-2495
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17663207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery