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General NPI Number Information
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NPI Number | 1609052117
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Entity Type | Individual
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Provider Name | RYAN M O'CONNOR M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 410 SAYBROOK ROAD SUITE 201
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-347-4620
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Fax | 860-346-9687
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Provider Business Mailing Address
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Address Line | 410 SAYBROOK ROAD SUITE 201
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-347-4620
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Fax | 860-346-9687
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 048583
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License Number State | CT
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