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General NPI Number Information
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NPI Number | 1962736611
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Entity Type | Individual
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Provider Name | DAVID L SIMON M.D., J.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 2 LEDGEBROOK DR FL 2
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1682
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Country | US
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Telephone | 860-356-2242
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Fax | 860-786-1192
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Provider Business Mailing Address
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Address Line | PO BOX 618
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-0618
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Country | US
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Telephone | 860-356-2242
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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 | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number | MD-050916L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number | 60-18004
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number | 154633
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number | 013633
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number | G88443
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 013633
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License Number State | CT
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Taxonomy #7
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 013633
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License Number State | CT
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Taxonomy #8
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Taxonomy Code | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number | 013633
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License Number State | CT
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Taxonomy #9
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number | 13633
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License Number State | CT
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