Provider Demographics
NPI:1538170493
Name:SAVARESE, MICHAEL DAMON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAMON
Last Name:SAVARESE
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 1:10 N BENSON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-3213
Mailing Address - Country:US
Mailing Address - Phone:203-758-1316
Mailing Address - Fax:203-758-1976
Practice Address - Street 1:10 N BENSON RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-3213
Practice Address - Country:US
Practice Address - Phone:203-758-1316
Practice Address - Fax:203-758-1976
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001317743Medicaid
CT110008664Medicare ID - Type Unspecified
CTE91602Medicare UPIN