Basic Information
| Provider Information | |||||||||
| NPI: | 1598938367 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HINDOLA KONRAD MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 NORTH ST | ||||||||
| Address2: | SUITE 415 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068105660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037940117 | ||||||||
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| Practice Location | |||||||||
| Address1: | 57 NORTH ST | ||||||||
| Address2: | SUITE 415 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068105660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037940117 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2008 | ||||||||
| LastUpdateDate: | 04/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 2037940117 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 037958 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 010037958CT01 | 01 | CT | BLUE CROSS BLUE SHIELD CT | OTHER |