1679590640 NPI number — DONALD J. AUSTRIAN MD PC

Table of content: (NPI 1679590640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679590640 NPI number — DONALD J. AUSTRIAN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONALD J. AUSTRIAN MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1679590640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 TECHNOLOGY DR
Provider Second Line Business Mailing Address:
STE. A203
Provider Business Mailing Address City Name:
TRUMBULL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06611-6337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-268-7620
Provider Business Mailing Address Fax Number:
203-445-0657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 TECHNOLOGY DR
Provider Second Line Business Practice Location Address:
STE. A203
Provider Business Practice Location Address City Name:
TRUMBULL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06611-6337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-268-7620
Provider Business Practice Location Address Fax Number:
203-445-0657
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AUSTRIAN
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
203-268-7620

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  26901 , 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: 010026901CT02 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0162694003 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4126325 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 526901 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: OV3162 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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