Provider Demographics
NPI:1053472647
Name:ECHEVERRI, ANA PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:PATRICIA
Last Name:ECHEVERRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 1/2 DEARFIELD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5335
Mailing Address - Country:US
Mailing Address - Phone:203-994-6547
Mailing Address - Fax:914-939-5696
Practice Address - Street 1:111 BEACH RD STE 3
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6668
Practice Address - Country:US
Practice Address - Phone:203-255-2340
Practice Address - Fax:203-255-0619
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-05-22
Deactivation Date:2023-04-10
Deactivation Code:
Reactivation Date:2023-05-22
Provider Licenses
StateLicense IDTaxonomies
CT042666207R00000X
NY208337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT042666OtherCT LICENSE
CT2961790415OtherPECOS PAC ID
CTCSP.0038698OtherCONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER
CTI20161017000301OtherENROLLMENT ID