Provider Demographics
NPI:1154332427
Name:RYDELL, MARGRET (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGRET
Middle Name:
Last Name:RYDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHAWS CV
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4956
Mailing Address - Country:US
Mailing Address - Phone:860-443-3788
Mailing Address - Fax:860-443-8820
Practice Address - Street 1:4 SHAWS CV
Practice Address - Street 2:SUITE 103
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4956
Practice Address - Country:US
Practice Address - Phone:860-443-3788
Practice Address - Fax:860-443-8820
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001379248Medicaid
CT001379248Medicaid
CT080001345Medicare ID - Type Unspecified