Provider Demographics
NPI:1033244892
Name:PATRICK R DUFFY MD LLC
Entity Type:Organization
Organization Name:PATRICK R DUFFY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-758-3163
Mailing Address - Street 1:166 WATERBURY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1246
Mailing Address - Country:US
Mailing Address - Phone:203-758-3163
Mailing Address - Fax:203-758-6021
Practice Address - Street 1:166 WATERBURY RD STE 301
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1246
Practice Address - Country:US
Practice Address - Phone:203-758-3163
Practice Address - Fax:203-758-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027466207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03326Medicare ID - Type UnspecifiedGROUP ID NUMBER