Healthcare Provider Details

I. General information

NPI: 1114047024
Provider Name (Legal Business Name): DANBURY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RESERVE RD STE A4
DANBURY CT
06810-5267
US

IV. Provider business mailing address

100 RESERVE RD STE A4
DANBURY CT
06810-5267
US

V. Phone/Fax

Practice location:
  • Phone: 203-794-1979
  • Fax: 203-794-1796
Mailing address:
  • Phone: 203-794-1979
  • Fax: 203-794-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3360762
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTIN H WILLIAMS
Title or Position: OWNER
Credential: MD
Phone: 203-794-1979