Provider Demographics
NPI:1922117787
Name:ASHMEAD, DUFFIELD IV (MD)
Entity Type:Individual
Prefix:DR
First Name:DUFFIELD
Middle Name:
Last Name:ASHMEAD
Suffix:IV
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 1:195 EASTERN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4353
Mailing Address - Country:US
Mailing Address - Phone:860-527-7161
Mailing Address - Fax:860-652-8410
Practice Address - Street 1:195 EASTERN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1208
Practice Address - Country:US
Practice Address - Phone:860-527-7161
Practice Address - Fax:860-652-8410
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0276692082S0105X, 2086S0105X, 2086S0122X
MA727022082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001276692Medicaid
CT001276692Medicaid
CTB39208Medicare UPIN