Healthcare Provider Details

I. General information

NPI: 1619063310
Provider Name (Legal Business Name): DANIEL R GROW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BATTERSON PARK RD
FARMINGTON CT
06032-2568
US

IV. Provider business mailing address

2 BATTERSON PARK RD
FARMINGTON CT
06032-2568
US

V. Phone/Fax

Practice location:
  • Phone: 844-467-3483
  • Fax: 860-838-6481
Mailing address:
  • Phone: 844-467-3483
  • Fax: 860-838-6481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number77730
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number56879
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: