Provider Demographics
NPI:1861434086
Name:KING, MICHAEL SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:115 TECHNOLOGY DR
Mailing Address - Street 2:SUITE B 302
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6337
Mailing Address - Country:US
Mailing Address - Phone:203-459-8712
Mailing Address - Fax:203-459-8739
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:SUITE B 302
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6337
Practice Address - Country:US
Practice Address - Phone:203-459-8712
Practice Address - Fax:203-459-8739
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT030566207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001305665Medicaid
CTA14236Medicare UPIN
CT001305665Medicaid