1225102247 NPI number — DAVID LONDON MD

Table of content: DAVID LONDON MD (NPI 1225102247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225102247 NPI number — DAVID LONDON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONDON
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225102247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
567 VAUXHALL STREET EXT
Provider Second Line Business Mailing Address:
SUITE 218
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06385-4330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-443-5822
Provider Business Mailing Address Fax Number:
860-444-0581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
567 VAUXHALL STREET EXTENSION
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-443-5822
Provider Business Practice Location Address Fax Number:
860-444-0581
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  017370 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NHSS04 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: MHN168798 . This is a "MHN" identifier . This identifiers is of the category "OTHER".




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