Healthcare Provider Details

I. General information

NPI: 1063776946
Provider Name (Legal Business Name): MARIA BYRNE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE LONG WHARF DRIVE SUITE #302
NEW HAVEN CT
06511
US

IV. Provider business mailing address

ONE LONG WHARF DRIVE SUITE #302
NEW HAVEN CT
06511
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-1932
  • Fax: 203-777-8469
Mailing address:
  • Phone: 203-777-1932
  • Fax: 203-777-8469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number029772
License Number StateCT

VIII. Authorized Official

Name: MARIA BYRNE
Title or Position: PHYSICIAN/SURGEON
Credential: MD
Phone: 203-777-1932