Provider Demographics
NPI:1609858414
Name:RADIN, ALAN MERVYN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MERVYN
Last Name:RADIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 DANBURY RD
Mailing Address - Street 2:WHITLOCK BUILDING SUITE 210
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:195 DANBURY RD
Practice Address - Street 2:WHITLOCK BUILDING SUITE 210
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4003
Practice Address - Country:US
Practice Address - Phone:203-762-3353
Practice Address - Fax:203-761-8563
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001205897Medicaid
CT110007728Medicare ID - Type Unspecified
CTD02571Medicare UPIN