Provider Demographics
NPI:1568412989
Name:KLIMOWICZ, DONNA W (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:W
Last Name:KLIMOWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3142
Mailing Address - Country:US
Mailing Address - Phone:203-878-6365
Mailing Address - Fax:
Practice Address - Street 1:949 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3142
Practice Address - Country:US
Practice Address - Phone:203-878-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0412042084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039244Medicaid
CT106276OtherMANAGED HEALTH NETWORK
CTANC1406OtherOXFORD BEHAVIORAL HEALTH
CT041204OtherPHYSICIAN/SURGEON
CT235143OtherCOMPSYCH
CT77ABH0005CT01OtherANTHEM BEHAVIORAL HEALTH
CT106276OtherMANAGED HEALTH NETWORK
CT260004117Medicare PIN