Healthcare Provider Details

I. General information

NPI: 1952420390
Provider Name (Legal Business Name): DAVID HENDRICKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E MAIN ST
BRANFORD CT
06405-2911
US

IV. Provider business mailing address

500 E MAIN ST
BRANFORD CT
06405-2911
US

V. Phone/Fax

Practice location:
  • Phone: 203-260-1375
  • Fax:
Mailing address:
  • Phone: 203-260-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number042.0016628
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number333822
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD495890
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number287808
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number34518
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number040912
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number37025
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: