Healthcare Provider Details

I. General information

NPI: 1528078995
Provider Name (Legal Business Name): ELIZABETH C. RIORDAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LEWIS AVE SUITE 208
MERIDEN CT
06451-2121
US

IV. Provider business mailing address

PO BOX 1065
WILBRAHAM MA
01095-7065
US

V. Phone/Fax

Practice location:
  • Phone: 203-238-2691
  • Fax: 203-235-3128
Mailing address:
  • Phone: 508-595-0531
  • Fax: 508-829-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number045438
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: