Provider Demographics
NPI:1689741753
Name:DUFFY, EILEEN J (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:J
Last Name:DUFFY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:145 TECHNOLOGY PKWY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2913
Mailing Address - Country:US
Mailing Address - Phone:770-800-7803
Mailing Address - Fax:770-248-6742
Practice Address - Street 1:3301 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4516
Practice Address - Country:US
Practice Address - Phone:763-712-4000
Practice Address - Fax:763-712-4013
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MN337182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF46344Medicare UPIN