Healthcare Provider Details

I. General information

NPI: 1316032295
Provider Name (Legal Business Name): DONALD GUSTAVE AMMERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 HOSPITAL AVE CPC ASSOCIATES
DANBURY CT
06810
US

IV. Provider business mailing address

84 HOSPITAL AVE CPC ASSOCIATES
DANBURY CT
06810
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-6060
  • Fax:
Mailing address:
  • Phone: 203-792-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRT1438
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number047925
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: