Provider Demographics
NPI:1972650281
Name:AXLINE, JOHN WARREN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WARREN
Last Name:AXLINE
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 1:401 SILVER SPRING RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-1944
Mailing Address - Country:US
Mailing Address - Phone:203-259-2427
Mailing Address - Fax:203-372-1985
Practice Address - Street 1:401 SILVER SPRING RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-1944
Practice Address - Country:US
Practice Address - Phone:203-259-2427
Practice Address - Fax:203-372-1985
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019427207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery