Provider Demographics
NPI:1841350964
Name:GARVEY, RICHARD J (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:GARVEY
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 1:310 MILL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2863
Mailing Address - Country:US
Mailing Address - Phone:203-366-3211
Mailing Address - Fax:203-366-1837
Practice Address - Street 1:310 MILL HILL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2863
Practice Address - Country:US
Practice Address - Phone:203-366-3211
Practice Address - Fax:203-366-1837
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021070208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001210707Medicaid
B73611Medicare UPIN
020000587Medicare ID - Type Unspecified