Provider Demographics
NPI:1124104724
Name:GIESEN, WILLIAM JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:GIESEN
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 1:1500 POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820
Mailing Address - Country:US
Mailing Address - Phone:203-655-2516
Mailing Address - Fax:203-656-3665
Practice Address - Street 1:1500 POST RD.
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820
Practice Address - Country:US
Practice Address - Phone:203-655-2516
Practice Address - Fax:203-656-3665
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT023721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
061258283OtherGUARDIAN
0697273OtherUS HEALTHCARE
4111798OtherAETNA
061258283OtherCHP
237210OtherCONNECTICARE
110006654Medicare ID - Type Unspecified
110009053Medicare PIN
0697273OtherUS HEALTHCARE