Healthcare Provider Details

I. General information

NPI: 1689655300
Provider Name (Legal Business Name): MICHAEL C. DRURY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

IV. Provider business mailing address

2800 MAIN ST
BRIDGEPORT CT
06606-4201
US

V. Phone/Fax

Practice location:
  • Phone: 475-210-5085
  • Fax: 475-210-5445
Mailing address:
  • Phone: 475-210-5085
  • Fax: 475-210-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001000
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: