Provider Demographics
NPI:1427304146
Name:HOLLINGSWORTH, BEVAN KURTHY (DPM)
Entity type:Individual
Prefix:DR
First Name:BEVAN
Middle Name:KURTHY
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:136 SHERMAN AVE 202
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5210
Mailing Address - Country:US
Mailing Address - Phone:203-624-9991
Mailing Address - Fax:203-624-6815
Practice Address - Street 1:267 GRANT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2805
Practice Address - Country:US
Practice Address - Phone:203-384-3000
Practice Address - Fax:203-384-3000
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT000924213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program