Provider Demographics
NPI:1598704637
Name:D'AMICO, JOHN F (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3721
Mailing Address - Country:US
Mailing Address - Phone:203-265-4814
Mailing Address - Fax:203-949-4741
Practice Address - Street 1:187 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-3721
Practice Address - Country:US
Practice Address - Phone:203-265-4814
Practice Address - Fax:203-949-4741
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000034213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOV1484OtherHEALTHNET PIN
CT00400666400OtherBLUECARE FAMILY
CT713035OtherCONNECTICARE PIN
CT203691700OtherDOL WC FED EMPLOYEES
CT030000034CT01OtherBC/BS PIN
CT5747116004OtherCIGNA PIN
CTZS225OtherOXFORD PIN
CT0517511OtherAETNA PIN
CT2704069OtherUHC PIN
CTOV1484OtherHEALTHNET PIN
CT442480088Medicare PIN
CT713035OtherCONNECTICARE PIN
CT2704069OtherUHC PIN
CT0517511OtherAETNA PIN
CTP00474911Medicare PIN