Provider Demographics
NPI:1720094188
Name:EILBOTT, DAVID JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JONATHAN
Last Name:EILBOTT
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 1:500 EAST MAIN ST
Mailing Address - Street 2:STE 212
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405
Mailing Address - Country:US
Mailing Address - Phone:203-481-5665
Mailing Address - Fax:203-481-5524
Practice Address - Street 1:500 EAST MAIN ST
Practice Address - Street 2:STE 212
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405
Practice Address - Country:US
Practice Address - Phone:203-481-5665
Practice Address - Fax:203-481-5524
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001251686Medicaid
B84022Medicare UPIN
CT001251686Medicaid