Provider Demographics
NPI:1912905621
Name:DUFFY, PATRICK R JR (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:DUFFY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:166 WATERBURY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1200
Mailing Address - Country:US
Mailing Address - Phone:203-758-3163
Mailing Address - Fax:203-758-6021
Practice Address - Street 1:166 WATERBURY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1200
Practice Address - Country:US
Practice Address - Phone:203-758-3163
Practice Address - Fax:203-758-6021
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT027466207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT201767500OtherUNITED HEALTH CARE
CT001274662Medicaid
CTP00209083OtherRR MEDICARE
CT010027466CT03OtherANTHEM BCBS NON PAR (LLC)
CTP1125487OtherOXFORD HEALTHPLANS
CTB38230Medicare UPIN
CT010027466CT03OtherANTHEM BCBS NON PAR (LLC)
CTB38230Medicare UPIN