Provider Demographics
NPI:1225134208
Name:EMMEL, DAVID KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEITH
Last Name:EMMEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2110 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2353
Mailing Address - Country:US
Mailing Address - Phone:860-258-3480
Mailing Address - Fax:860-571-6800
Practice Address - Street 1:1260 SILAS DEANE HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4362
Practice Address - Country:US
Practice Address - Phone:860-721-8960
Practice Address - Fax:860-563-2030
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT24341207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT052156OtherHEALTHNET
CT0243410OtherCONNECTICARE
CT0811678OtherAETNA
CT010024341CT01OtherBLUE CROSS
CTP2043695OtherOXFORD
CT001243419Medicaid
CT180000332Medicare ID - Type Unspecified
CT001243419Medicaid