Healthcare Provider Details

I. General information

NPI: 1306820956
Provider Name (Legal Business Name): RICHARD WILBROD DUROCHER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WASHINGTON AVE STE 212
NORTH HAVEN CT
06473-2343
US

IV. Provider business mailing address

20 WASHINGTON AVE STE 212
NORTH HAVEN CT
06473-2343
US

V. Phone/Fax

Practice location:
  • Phone: 203-239-1119
  • Fax: 203-234-1832
Mailing address:
  • Phone: 203-239-1119
  • Fax: 203-234-1832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00709
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000709
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2097
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: