Healthcare Provider Details

I. General information

NPI: 1699161075
Provider Name (Legal Business Name): DENZIL DOUGLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KINGS HWY E STE 109
FAIRFIELD CT
06825-4871
US

IV. Provider business mailing address

PO BOX 416173
BOSTON MA
02241-6173
US

V. Phone/Fax

Practice location:
  • Phone: 203-330-0248
  • Fax:
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number301732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: