| Avanta Clinic Llc | |
|
131 New London Tpke Ste 105 Glastonbury CT 06033 | |
| (860) 430-5599 | |
| Not Available |
| Full Name | Avanta Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 131 New London Tpke Ste 105, Glastonbury, Connecticut |
| Authorized Official Name and Position | Sudeep Bansal (OWNER) |
| Authorized Official Contact | 8604305599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avanta Clinic Llc 131 New London Tpke Ste 105 Glastonbury CT 06033-2246 Ph: () - | Avanta Clinic Llc 131 New London Tpke Ste 105 Glastonbury CT 06033 Ph: (860) 430-5599 |
| NPI Number | 1619467826 |
|---|---|
| Provider Enumeration Date | 05/14/2018 |
| Last Update Date | 08/28/2018 |
| Medicare PECOS PAC ID | 9931456894 |
|---|---|
| Medicare Enrollment ID | O20180724000695 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619467826 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Sudeep Bansal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346437233 PECOS PAC ID: 5698829570 Enrollment ID: I20090811000582 |
| Provider Name | Robin J Bansal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659932333 PECOS PAC ID: 6709113350 Enrollment ID: I20190806001587 |
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