Provider Demographics
NPI:1760640643
Name:HOUSMAN, DOUGLAS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:HOUSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 NEWELL ROAD
Mailing Address - Street 2:SUITE C11
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5100
Mailing Address - Country:US
Mailing Address - Phone:860-582-9800
Mailing Address - Fax:860-585-0059
Practice Address - Street 1:25 NEWELL ROAD
Practice Address - Street 2:SUITE C11
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5100
Practice Address - Country:US
Practice Address - Phone:860-582-9800
Practice Address - Fax:860-585-0059
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0501352085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008038080Medicaid
CT008038080Medicaid