Provider Demographics
NPI:1902149370
Name:BROCKINGTON, ANTHONY (DPM)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BROCKINGTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:BROCKINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:51 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4204
Mailing Address - Country:US
Mailing Address - Phone:860-582-0747
Mailing Address - Fax:860-585-8124
Practice Address - Street 1:51 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4204
Practice Address - Country:US
Practice Address - Phone:860-582-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2192213ES0103X
CT1086213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery