=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538170493
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL DAMON SAVARESE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 06/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 N BENSON RD
-----------------------------------------------------
City | MIDDLEBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06762-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-758-1316
-----------------------------------------------------
Fax | 203-758-1976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 N BENSON RD
-----------------------------------------------------
City | MIDDLEBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06762-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-758-1316
-----------------------------------------------------
Fax | 203-758-1976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 031774
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------