Provider Demographics
NPI:1679065064
Name:DAVITT, KATLIN MCCLENAGHAN (DO)
Entity type:Individual
Prefix:
First Name:KATLIN
Middle Name:MCCLENAGHAN
Last Name:DAVITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 PARK AVE # WP2-700
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3463
Mailing Address - Country:US
Mailing Address - Phone:203-374-1018
Mailing Address - Fax:203-396-0699
Practice Address - Street 1:5520 PARK AVE # WP2-700
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3463
Practice Address - Country:US
Practice Address - Phone:203-374-1018
Practice Address - Fax:203-396-0699
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT074144207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology