Provider Demographics
NPI:1679590640
Name:DONALD J. AUSTRIAN MD PC
Entity Type:Organization
Organization Name:DONALD J. AUSTRIAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:AUSTRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-268-7620
Mailing Address - Street 1:115 TECHNOLOGY DR
Mailing Address - Street 2:STE. A203
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6337
Mailing Address - Country:US
Mailing Address - Phone:203-268-7620
Mailing Address - Fax:203-445-0657
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:STE. A203
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6337
Practice Address - Country:US
Practice Address - Phone:203-268-7620
Practice Address - Fax:203-445-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT26901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010026901CT02OtherBLUE CROSS BLUE SHIELD
CT0162694003OtherCIGNA
CT4126325OtherAETNA
CT526901OtherCONNECTICARE
CTOV3162OtherHEALTHNET
CTB84479Medicare UPIN