Provider Demographics
NPI:1780861997
Name:DAVID, OLIVER J (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:J
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:187 ESSEX ST
Mailing Address - Street 2:PO BOX 948
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-1946
Mailing Address - Country:US
Mailing Address - Phone:860-526-3712
Mailing Address - Fax:
Practice Address - Street 1:187 ESSEX ST
Practice Address - Street 2:BOX 948
Practice Address - City:DEEP RIVER
Practice Address - State:CT
Practice Address - Zip Code:06417-1946
Practice Address - Country:US
Practice Address - Phone:860-526-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090920-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry