Healthcare Provider Details

I. General information

NPI: 1386783371
Provider Name (Legal Business Name): KATHLEEN MAXFIELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 GERMANTOWN RD
DANBURY CT
06810-4087
US

IV. Provider business mailing address

41 GERMANTOWN RD
DANBURY CT
06810-4087
US

V. Phone/Fax

Practice location:
  • Phone: 203-399-0399
  • Fax:
Mailing address:
  • Phone: 203-399-0399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2006-0340
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberNH17929
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number34011
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number72618
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: