Healthcare Provider Details

I. General information

NPI: 1952712721
Provider Name (Legal Business Name): PERRY K. PRATT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 SAYBROOK RD STE 201
MIDDLETOWN CT
06457-4777
US

IV. Provider business mailing address

410 SAYBROOK RD STE 201
MIDDLETOWN CT
06457-4777
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-4620
  • Fax: 860-346-9687
Mailing address:
  • Phone: 860-347-4620
  • Fax: 860-346-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number67590
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number67590
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: