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General NPI Number Information
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NPI Number | 1700820008
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Entity Type | Individual
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Provider Name | DRAGOSLAV DRCA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 1320 W MAIN ST BUILDING 1, UNIT 1
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City | WATERBURY
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State | CT
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Zip | 06708-3119
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Country | US
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Telephone | 203-755-9960
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Fax | 203-755-5234
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Provider Business Mailing Address
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Address Line | 56 FRANKLIN ST 3RD FLOOR
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City | WATERBURY
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State | CT
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Zip | 06706-1221
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Country | US
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Telephone | 203-709-8873
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Fax | 203-709-8689
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 044036
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License Number State | CT
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