Provider Demographics
NPI:1841239068
Name:WASSERSTEIN, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WASSERSTEIN
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 1:27 NAEK ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066
Mailing Address - Country:US
Mailing Address - Phone:860-875-2444
Mailing Address - Fax:
Practice Address - Street 1:27 NAEK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3942
Practice Address - Country:US
Practice Address - Phone:860-875-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032853207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001328534Medicaid
CT001328534Medicaid
CT290000239Medicare PIN