Provider Demographics
NPI:1831293570
Name:HEFFELFINGER, RYAN M (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:HEFFELFINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 DAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-5719
Mailing Address - Country:US
Mailing Address - Phone:860-683-2690
Mailing Address - Fax:860-683-2670
Practice Address - Street 1:1060 DAY HILL RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-5719
Practice Address - Country:US
Practice Address - Phone:860-683-2690
Practice Address - Fax:860-683-2670
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831293570OtherNPI
1831293570OtherNPI