Provider Demographics
NPI:1871251728
Name:FLAUGH, MAXWELL DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:DAVID
Last Name:FLAUGH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 STRAITS TPKE STE E
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1841
Mailing Address - Country:US
Mailing Address - Phone:203-598-0701
Mailing Address - Fax:877-345-6922
Practice Address - Street 1:1579 STRAITS TPKE STE E
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1841
Practice Address - Country:US
Practice Address - Phone:203-598-0701
Practice Address - Fax:877-345-6922
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23.005515363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical