Provider Demographics
NPI:1194700666
Name:FIELLIN, DAVID AUGUSTUS (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:AUGUSTUS
Last Name:FIELLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 GEORGE ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6624
Mailing Address - Country:US
Mailing Address - Phone:203-785-4216
Mailing Address - Fax:203-785-6414
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:YNHH
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-688-2471
Practice Address - Fax:203-688-4516
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2013-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT033601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001336016Medicaid
CT001336016Medicaid
F81088Medicare UPIN