MEDICARE: RICHARD EUBANKS FEARON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	011447	CT

General Provider Information

NPI Number	:	1033366067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD EUBANKS FEARON

Provider Business Mailing Address
First Line	:	20 BROOK RD
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525
Country	:	US
Telephone Number	:	203-397-0551
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 BROOK RD
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525
Country	:	US
Telephone Number	:	203-397-0551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	05/10/2026

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