Healthcare Provider Details

I. General information

NPI: 1154500692
Provider Name (Legal Business Name): DONALD S. BIALOS, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SAMSON ROCK DR
MADISON CT
06443-3005
US

IV. Provider business mailing address

4 MEIGS AV
MADISON CT
06443-1920
US

V. Phone/Fax

Practice location:
  • Phone: 203-245-7721
  • Fax:
Mailing address:
  • Phone: 203-245-7721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number013127
License Number StateCT

VIII. Authorized Official

Name: DR. DONALD S. BIALOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-245-7721