Provider Demographics
NPI:1144255332
Name:NOTARO, WILLIAM A (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:NOTARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27 HOSPITAL AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5954
Mailing Address - Country:US
Mailing Address - Phone:203-790-7585
Mailing Address - Fax:203-790-4040
Practice Address - Street 1:27 HOSPITAL AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5954
Practice Address - Country:US
Practice Address - Phone:203-790-7585
Practice Address - Fax:203-790-4040
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT025530207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001255306Medicaid
NY00996736Medicaid
NY00996736Medicaid
070000136Medicare PIN