Provider Demographics
NPI:1497923734
Name:E STEVEN DAMON, D.P.M.
Entity Type:Organization
Organization Name:E STEVEN DAMON, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DAMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-745-6248
Mailing Address - Street 1:64 PALOMBA DR
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3844
Mailing Address - Country:US
Mailing Address - Phone:860-745-6248
Mailing Address - Fax:860-741-2482
Practice Address - Street 1:64 PALOMBA DR
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3844
Practice Address - Country:US
Practice Address - Phone:860-745-6248
Practice Address - Fax:860-741-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000035213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4006102Medicaid
CT480000194Medicare PIN
CTT22025Medicare UPIN
CT1019700001Medicare NSC