Provider Demographics
NPI:1740235282
Name:MAXWELL, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 COTTAGE GROVE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3119
Mailing Address - Country:US
Mailing Address - Phone:860-242-0034
Mailing Address - Fax:860-242-3301
Practice Address - Street 1:421 COTTAGE GROVE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3119
Practice Address - Country:US
Practice Address - Phone:860-242-0034
Practice Address - Fax:860-242-3301
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT026642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001266429Medicaid
CT001266429Medicaid