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General NPI Number Information
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NPI Number | 1598925612
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Entity Type | Individual
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Provider Name | KERIAN SERVICE M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 12/23/2011
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Provider Practice Location Address
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Address Line | 150 N MAIN ST
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City | MANCHESTER
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State | CT
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Zip | 06042-2003
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Country | US
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Telephone | 860-528-1359
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Fax | 860-290-4142
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Provider Business Mailing Address
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Address Line | 94 CONNECTICUT BLVD
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City | EAST HARTFORD
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State | CT
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Zip | 06108-3013
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Country | US
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Telephone | 860-528-1359
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Fax | 860-290-4142
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 049742
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License Number State | CT
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