Healthcare Provider Details

I. General information

NPI: 1063451201
Provider Name (Legal Business Name): PAUL DEAN DEMARTINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KINGS HWY E SUITE 112
FAIRFIELD CT
06825-4867
US

IV. Provider business mailing address

501 KINGS HWY E
FAIRFIELD CT
06825-4867
US

V. Phone/Fax

Practice location:
  • Phone: 203-382-1900
  • Fax: 203-382-0019
Mailing address:
  • Phone: 203-382-1900
  • Fax: 203-382-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number024378
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: