Individual provider Active NPI

Joycelyn Dadural Maw, M.D.

  • Internal Medicine Physician
  • Middlebury, CT
National Provider Identifier
1629166574
Registry record updated Oct 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
047385 Issued in CT
Practice address
1626 Straits Turnpike
Suite 110
Middlebury, CT 06762-1009
Phone
(203) 758-8107
Fax
(203) 568-2924
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 4, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X TRN7901 FL
Internal Medicine Physician 207R00000X 047385 CT Primary

Addresses

Primary practice location

1626 Straits Turnpike
Suite 110
Middlebury, CT 06762-1009

Mailing address

40 Mayflower Cir
Fairfield, CT 06824-3936
Phone (352) 219-8812

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090818000473 CT Practitioner - Internal Medicine 9436203908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York Medical College, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prospect CT Medical Foundation IncGroup PAC ID 7416244496, 287 clinicians

Practice addresses (Care Compare)

1625 Straits Tpke
Middlebury, CT 06762-1836
Phone (203) 758-8107

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
047385CTMDInternal Medicine Physician
TRN7901FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect CT Medical Foundation, Inc. Internal Medicine CurrentSince Sep 1, 2016 Accepting new patients

Locations

1801 W Olympic Blvd
#2201
Pasadena, CA 91199

18 Haynes St
Uppr
Manchester, CT 06040
Phone (860) 649-7557

1625 Straits Tpke
Ste 302
Middlebury, CT 06762
Phone (203) 759-0666

1625 Straits Tpke
Ste 110
Middlebury, CT 06762
Phone (203) 758-8107

1625 Straits Tpke
Ste 301
Middlebury, CT 06762
Phone (203) 573-7281

1625 Straits Tpke
Ste 201
Middlebury, CT 06762
Phone (203) 573-9512

1625 Straits Tpke
Ste 211
Middlebury, CT 06762
Phone (203) 573-9512

Interoperability endpoints

  • Direct secure messaging: joycelynmaw@amggw.allscriptsdirect.net

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349308800000",
    "number": "1629166574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 MAYFLOWER CIR",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068243936",
            "telephone_number": "352-219-8812",
            "fax_number": "203-568-2924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 STRAITS TURNPIKE",
            "address_2": "SUITE 110",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067621009",
            "telephone_number": "203-758-8107",
            "fax_number": "203-568-2924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAW",
        "first_name": "JOYCELYN",
        "middle_name": "DADURAL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2012-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "TRN7901",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "047385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlebury, CT

Sources for this page

Verify at the official NPI Registry.