Provider Demographics
NPI:1316008360
Name:EWING, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:EWING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TITUS RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON DEPOT
Mailing Address - State:CT
Mailing Address - Zip Code:06794-1517
Mailing Address - Country:US
Mailing Address - Phone:860-868-1155
Mailing Address - Fax:860-868-1288
Practice Address - Street 1:8 TITUS RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON DEPOT
Practice Address - State:CT
Practice Address - Zip Code:06794-1517
Practice Address - Country:US
Practice Address - Phone:860-868-1155
Practice Address - Fax:860-868-1288
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0339492084A0401X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry