Provider Demographics
NPI:1518952241
Name:VIETS, DOUGLAS HARTLEY
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HARTLEY
Last Name:VIETS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 416
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-947-8500
Mailing Address - Fax:860-524-8643
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE 416
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-947-8500
Practice Address - Fax:860-524-8643
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021157208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0S0312OtherHEALTH NET
CT076141OtherCONNECTICARE
CT17464OtherHEALTH NEW ENGLAND
CTP1314456OtherOXFORD
CT010021157CT01OtherANTHEM BLUE CROSS
MA3164942Medicaid
CT0174370 001OtherCIGNA
CT2054418OtherAETNA
CT076141OtherCONNECTICARE