Provider Demographics
NPI:1689660771
Name:FARMER, WILLIAM DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:FARMER
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 1:2447 WHITNEY AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3211
Mailing Address - Country:US
Mailing Address - Phone:203-230-5888
Mailing Address - Fax:203-230-5889
Practice Address - Street 1:2447 WHITNEY AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3211
Practice Address - Country:US
Practice Address - Phone:203-230-5888
Practice Address - Fax:203-230-5889
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT9800001901OtherMEDICARE ID
H69095Medicare UPIN