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Contact Information

MARK D DEPONTE, MD
2 LEE RD
LISBON, CT06351
 Phone: 860-376-4451
 Fax: 860-376-5977
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for MARK D DEPONTE · (Male)

NPI # 1265434583
Status Active
Credentials MD
Entity Individual
Enumeration date 06/01/2005
Last updated 11/19/2009 - About 17 years ago
Sole proprietor 1 Yes
Identifiers
  • CT License # 039945
  • CT Medicaid 001399452
  • Other 010039945CT01 BCBS
  • Other 020323907 CIGNA
  • Other 2V1508 HEALTHNET
  • Other 020323907 UNHC
Hospital affiliation(s)
  • WILLIAM W BACKUS HOSPITAL - (Acute Care)
    326 WASHINGTON ST
    NORWICH, CT 06360
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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