Healthcare Provider Details

I. General information

NPI: 1750343117
Provider Name (Legal Business Name): RICHARD G PUGLIESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 BROAD ST
MIDDLETOWN CT
06457-3204
US

IV. Provider business mailing address

51 BROAD ST
MIDDLETOWN CT
06457-3204
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-3401
  • Fax: 860-358-3403
Mailing address:
  • Phone: 860-358-3401
  • Fax: 860-358-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number030668
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30668
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: