Provider Demographics
NPI:1063458396
Name:MARI, EDUARDO G (MD)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:G
Last Name:MARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1389 WEST MAIN ST
Mailing Address - Street 2:SUITE 223
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-755-2268
Mailing Address - Fax:203-574-5500
Practice Address - Street 1:1389 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-755-2268
Practice Address - Fax:203-574-5500
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016642207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001166420Medicaid
CT001166420Medicaid
D02706Medicare UPIN