Provider Demographics
NPI:1760484067
Name:DREISS, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:DREISS
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 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-224-6205
Mailing Address - Fax:860-826-4957
Practice Address - Street 1:300 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3916
Practice Address - Country:US
Practice Address - Phone:860-224-6205
Practice Address - Fax:860-826-4957
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026770207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP369885OtherOXFORD PROV ID
CT060086OtherHEALTH NET PROV ID
CT3062401OtherCONNECTICARE ID
CT01026770OtherCIGNA PROV ID
CT487984OtherAETNA REF ID
CT010026770CT01OtherBCBS N BCFP PROV ID
CT1255448155OtherGHMC GROUP NPI
CT367557OtherWELLCARE MEDICARE ONLY
CT060086OtherHEALTH NET PROV ID
CT010026770CT01OtherBCBS N BCFP PROV ID