Healthcare Provider Details

I. General information

NPI: 1689698656
Provider Name (Legal Business Name): MARY CATHERINE REDMOND P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE RD EMERGENCY DEPARTMENT
GREENWICH CT
06830-4608
US

IV. Provider business mailing address

5 PERRYRIDGE RD EMERGENCY DEPARTMENT
GREENWICH CT
06830-4608
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3637
  • Fax: 203-863-3821
Mailing address:
  • Phone: 203-863-3637
  • Fax: 203-863-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001674
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: