Provider Demographics
NPI:1790729093
Name:AGIN, ELLIOT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:DAVID
Last Name:AGIN
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 1:849 BOSTON POST RD
Mailing Address - Street 2:200
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3537
Mailing Address - Country:US
Mailing Address - Phone:203-874-1512
Mailing Address - Fax:203-874-3877
Practice Address - Street 1:849 BOSTON POST RD
Practice Address - Street 2:200
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3537
Practice Address - Country:US
Practice Address - Phone:203-874-1512
Practice Address - Fax:203-874-3877
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25364207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1253640Medicaid
CT1253640Medicaid