Provider Demographics
NPI:1659344596
Name:WOLLMAN, DANIEL ERIC (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ERIC
Last Name:WOLLMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5323
Mailing Address - Country:US
Mailing Address - Phone:203-225-0504
Mailing Address - Fax:203-792-1675
Practice Address - Street 1:31 STAPLES ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5323
Practice Address - Country:US
Practice Address - Phone:203-225-0504
Practice Address - Fax:203-792-1675
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038204207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT380000158Medicare ID - Type UnspecifiedMEDICARE ID
CTH77686Medicare UPIN