Healthcare Provider Details

I. General information

NPI: 1285192815
Provider Name (Legal Business Name): BRIAN EDWARD MCCARTY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2019
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST
NORWALK CT
06850
US

IV. Provider business mailing address

356 WHEELERS FARMS RD APT 2-202
MILFORD CT
06461-1971
US

V. Phone/Fax

Practice location:
  • Phone: 866-642-9355
  • Fax:
Mailing address:
  • Phone: 347-578-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8616
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: