Healthcare Provider Details

I. General information

NPI: 1659344596
Provider Name (Legal Business Name): DANIEL ERIC WOLLMAN M.D, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BRIDGEPORT AVE STE 2
SHELTON CT
06484-4892
US

IV. Provider business mailing address

555 BRIDGEPORT AVE STE 2
SHELTON CT
06484-4892
US

V. Phone/Fax

Practice location:
  • Phone: 203-225-0504
  • Fax: 203-792-1675
Mailing address:
  • Phone: 203-225-0504
  • Fax: 203-792-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number283995
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number038204
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number038204
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number283995
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: