Provider Demographics
NPI:1609851369
Name:HANDELMAN, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:HANDELMAN
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 1:30 PECK RD
Mailing Address - Street 2:STE 2201
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6123
Mailing Address - Country:US
Mailing Address - Phone:860-489-1984
Mailing Address - Fax:860-496-2195
Practice Address - Street 1:30 PECK RD STE 2201
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-489-1984
Practice Address - Fax:860-496-2195
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020074207R00000X
CT022074207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1220748Medicaid
CTP4907982OtherOXFORD
562593OtherAETNA
CT010022074CT01OtherANTHEM
390004290OtherRR MEDICARE
752465OtherCONNECTICARE
562593OtherAETNA
B38327Medicare UPIN
CT010022074CT01OtherANTHEM