Provider Demographics
NPI:1366440026
Name:AMIR, DORON (MD)
Entity Type:Individual
Prefix:DR
First Name:DORON
Middle Name:
Last Name:AMIR
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 1:439 MILL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2866
Mailing Address - Country:US
Mailing Address - Phone:203-334-2100
Mailing Address - Fax:203-333-5864
Practice Address - Street 1:439 MILL HILL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2866
Practice Address - Country:US
Practice Address - Phone:203-334-2100
Practice Address - Fax:203-333-5864
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033357207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001333575Medicaid
CT001333575Medicaid
CT060001053Medicare PIN