Provider Demographics
NPI:1740510056
Name:MARIE-ANNE DENAYER M.D. LLC
Entity type:Organization
Organization Name:MARIE-ANNE DENAYER M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-276-3857
Mailing Address - Street 1:360 N MAIN ST STE 8
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2503
Mailing Address - Country:US
Mailing Address - Phone:860-276-3857
Mailing Address - Fax:860-276-8198
Practice Address - Street 1:360 N MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2503
Practice Address - Country:US
Practice Address - Phone:860-276-3857
Practice Address - Fax:860-276-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0250122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT025012OtherLICENSE
CT130000464OtherMEDICARE ID
CTAD2469826OtherDEA
CT130000464OtherMEDICARE ID