Healthcare Provider Details

I. General information

NPI: 1679640460
Provider Name (Legal Business Name): WILLIAM T FLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 EAST AVENUE
NEW CANAAN CT
06840
US

IV. Provider business mailing address

173 EAST AVENUE
NEW CANAAN CT
06840
US

V. Phone/Fax

Practice location:
  • Phone: 203-972-4250
  • Fax: 203-801-2126
Mailing address:
  • Phone: 203-972-4250
  • Fax: 203-801-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number033199
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: