Healthcare Provider Details

I. General information

NPI: 1912905621
Provider Name (Legal Business Name): PATRICK R DUFFY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 WATERBURY RD SUITE 301
PROSPECT CT
06712-1200
US

IV. Provider business mailing address

166 WATERBURY RD SUITE 301
PROSPECT CT
06712-1200
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-3163
  • Fax: 203-758-6021
Mailing address:
  • Phone: 203-758-3163
  • Fax: 203-758-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number027466
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: