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General NPI Number Information
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NPI Number | 1548599616
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Entity Type | Organization
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Legal Business Name | BRIAN EDDY, M.D. LLC
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Dates
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Enumeration Date | 12/18/2009
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Last Update Date | 12/18/2009
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Provider Practice Location Address
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Address Line | 1224 FARMINGTON AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2668
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Country | US
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Telephone | 860-760-6857
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Fax | 860-499-5230
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Provider Business Mailing Address
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Address Line | 1224 FARMINGTON AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06107-2668
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Country | US
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Telephone | 860-760-6857
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Fax | 860-499-5230
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. BRIAN C EDDY
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Credential | M.D.
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Telephone | 860-760-6857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 044569
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License Number State | CT
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