Provider Demographics
NPI:1710997481
Name:LEARY, CHRISTOPHER JON (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JON
Last Name:LEARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 FARMINGTON AVE
Mailing Address - Street 2:PO BOX 277
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-0277
Mailing Address - Country:US
Mailing Address - Phone:860-584-1320
Mailing Address - Fax:860-584-2152
Practice Address - Street 1:25 COLLINS RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-584-0541
Practice Address - Fax:860-584-9998
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT353622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001353622Medicaid
CT001353622Medicaid