Provider Demographics
NPI:1609859842
Name:DUFOUR, KAREN SHANAHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:SHANAHAN
Last Name:DUFOUR
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 1:325 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3504
Mailing Address - Country:US
Mailing Address - Phone:203-795-0568
Mailing Address - Fax:203-795-0436
Practice Address - Street 1:325 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3504
Practice Address - Country:US
Practice Address - Phone:203-795-0568
Practice Address - Fax:203-795-0436
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028102207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB38425Medicare UPIN
CT110007599Medicare ID - Type Unspecified