| Mark D. Deponte, M.d.,llc | |
|
2 Lee Rd Lisbon CT 06351-3015 | |
| (860) 376-4451 | |
| (860) 376-5977 |
| Full Name | Mark D. Deponte, M.d.,llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2 Lee Rd, Lisbon, Connecticut |
| Authorized Official Name and Position | Mark D Deponte (OWNER) |
| Authorized Official Contact | 8603764451 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark D. Deponte, M.d.,llc 2 Lee Rd Lisbon CT 06351-3015 Ph: (860) 376-4451 | Mark D. Deponte, M.d.,llc 2 Lee Rd Lisbon CT 06351-3015 Ph: (860) 376-4451 |
| NPI Number | 1548591597 |
|---|---|
| Provider Enumeration Date | 01/14/2010 |
| Last Update Date | 01/14/2010 |
| Medicare PECOS PAC ID | 8325181019 |
|---|---|
| Medicare Enrollment ID | O20100203000355 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548591597 | NPI | - | NPPES |
| 780555 | Other | CT | CONNECTICARE |
| 2V1508 | Other | CT | HEALTHNET |
| 001399452 | Medicaid | CT | |
| 010039945CT01 | Other | CT | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 39445 (Connecticut) | Primary |
| Provider Name | Mark D Deponte |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265434583 PECOS PAC ID: 9335282029 Enrollment ID: I20100203000351 |
| Provider Name | Tonia Soper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720863814 PECOS PAC ID: 4082060694 Enrollment ID: I20231101003333 |
Bert Coppotelli Md Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2 Lee Rd, Lisbon, CT 06351 Phone: 860-376-4451 Fax: 860-376-5977 |