Provider Demographics
NPI:1063413615
Name:SALZBERG, DONALD JAMES (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JAMES
Last Name:SALZBERG
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 1:836 FARMINGTON AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1505
Mailing Address - Country:US
Mailing Address - Phone:860-233-2346
Mailing Address - Fax:860-236-3607
Practice Address - Street 1:836 FARMINGTON AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1505
Practice Address - Country:US
Practice Address - Phone:860-233-2346
Practice Address - Fax:860-236-3607
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2015-09-10
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CT207W00000X207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001256353Medicaid
CT061190847Medicare PIN
CTB83325Medicare UPIN