Provider Demographics
NPI:1417937475
Name:COURTRIGHT, DARREN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:J
Last Name:COURTRIGHT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 POHEGANUT DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3252
Mailing Address - Country:US
Mailing Address - Phone:860-437-3737
Mailing Address - Fax:860-437-0530
Practice Address - Street 1:85 POHEGANUT DR
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3252
Practice Address - Country:US
Practice Address - Phone:860-437-3737
Practice Address - Fax:860-437-0530
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000607213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1417937475Medicaid
CTU45818Medicare UPIN
CT480000743Medicare PIN