Provider Demographics
NPI:1205043486
Name:WADDINGTON, MICHAEL D (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:WADDINGTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 EASTERN BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4325
Mailing Address - Country:US
Mailing Address - Phone:860-993-3516
Mailing Address - Fax:860-430-6885
Practice Address - Street 1:78 EASTERN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4325
Practice Address - Country:US
Practice Address - Phone:860-993-3516
Practice Address - Fax:860-430-6885
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016862204D00000X
CT53391204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008055817Medicaid
MO1609021104Medicaid