Healthcare Provider Details

I. General information

NPI: 1609855592
Provider Name (Legal Business Name): VICTOR TIRADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 SILAS DEANE HWY 2ND FLOOR WEST
WETHERSFIELD CT
06109-4220
US

IV. Provider business mailing address

929 SILAS DEANE HWY 2ND FLOOR WEST
WETHERSFIELD CT
06109-4220
US

V. Phone/Fax

Practice location:
  • Phone: 860-372-4731
  • Fax: 860-372-4730
Mailing address:
  • Phone: 860-372-4731
  • Fax: 860-372-4730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042939
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: