Healthcare Provider Details

I. General information

NPI: 1922117787
Provider Name (Legal Business Name): DUFFIELD ASHMEAD IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 HEBRON AVE STE 205
GLASTONBURY CT
06033-2421
US

IV. Provider business mailing address

622 HEBRON AVE STE 205
GLASTONBURY CT
06033-2421
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-7161
  • Fax: 860-652-8410
Mailing address:
  • Phone: 860-527-7161
  • Fax: 860-652-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number027669
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number72702
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number027669
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number027669
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: