Provider Demographics
NPI:1457326837
Name:ARRIETA, EDNA J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:J
Last Name:ARRIETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:953 MAIN ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6014
Mailing Address - Country:US
Mailing Address - Phone:860-649-1550
Mailing Address - Fax:860-649-1091
Practice Address - Street 1:31 UNION ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-3126
Practice Address - Country:US
Practice Address - Phone:860-649-1550
Practice Address - Fax:860-649-1091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT016874207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0500001070Medicare ID - Type Unspecified
D77013Medicare UPIN