Healthcare Provider Details

I. General information

NPI: 1770512915
Provider Name (Legal Business Name): BRIAN D BAXT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 POMFRET ST
PUTNAM CT
06260-1869
US

IV. Provider business mailing address

83 VALLEY STREAM LN
SOUTHBURY CT
06488-4681
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-6451
  • Fax:
Mailing address:
  • Phone: 203-910-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number037012
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number97514
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number037012
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: