Healthcare Provider Details

I. General information

NPI: 1740639913
Provider Name (Legal Business Name): DANBURY MIDWIFERY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 LOCUST AVE
DANBURY CT
06810-6032
US

IV. Provider business mailing address

94 LOCUST AVE
DANBURY CT
06810-6032
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-6000
  • Fax: 203-748-6771
Mailing address:
  • Phone: 203-748-6000
  • Fax: 203-748-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number030587
License Number StateCT

VIII. Authorized Official

Name: DR. KENNETH PAUL BLAU
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 203-748-6000