Healthcare Provider Details

I. General information

NPI: 1780654897
Provider Name (Legal Business Name): CLAUDIA M BAXTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PARK LANE RD SUITE B-202
NEW MILFORD CT
06776-2444
US

IV. Provider business mailing address

120 PARK LANE RD SUITE B-202
NEW MILFORD CT
06776-2444
US

V. Phone/Fax

Practice location:
  • Phone: 860-210-0082
  • Fax: 860-210-1633
Mailing address:
  • Phone: 860-210-0082
  • Fax: 860-210-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number042570
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: