Healthcare Provider Details

I. General information

NPI: 1700922630
Provider Name (Legal Business Name): MICHAEL E NOTTIDGE MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 FRANKLIN ST EMERGENCY DEPARTMENT
WATERBURY CT
06706-1253
US

IV. Provider business mailing address

56 FRANKLIN ST
WATERBURY CT
06706-1253
US

V. Phone/Fax

Practice location:
  • Phone: 203-709-5354
  • Fax:
Mailing address:
  • Phone: 203-709-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number1015218
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1015218
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number048159
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT4326
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: