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General NPI Number Information
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NPI Number | 1467847780
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Entity Type | Individual
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Provider Name | DOUGLAS E ZELISKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 1000 SILVER STREET
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-293-6441
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Fax |
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Provider Business Mailing Address
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Address Line | 200 RETREAT AVENUE HARTFORD HOSPITAL PSYCHIATRY DEPT
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City | HARTFORD
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State | CT
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Zip | 06106-3309
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Country | US
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Telephone | 860-545-7063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 065291
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License Number State | CT
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