Provider Demographics
NPI:1316381494
Name:STAUDACHER, DAVID ALAN (VMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:STAUDACHER
Suffix:
Gender:M
Credentials:VMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LOVELY ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2630
Mailing Address - Country:US
Mailing Address - Phone:860-693-0214
Mailing Address - Fax:860-693-1432
Practice Address - Street 1:60 LOVELY ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2630
Practice Address - Country:US
Practice Address - Phone:860-693-0214
Practice Address - Fax:860-693-1432
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2045174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTBS 1308647OtherDEA