Provider Demographics
NPI:1952381758
Name:REARDON, PATRICIA CATON (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:CATON
Last Name:REARDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 QUARRY ST
Mailing Address - Street 2:PO BOX 16
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-1238
Mailing Address - Country:US
Mailing Address - Phone:860-423-1619
Mailing Address - Fax:860-423-7640
Practice Address - Street 1:83 QUARRY ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226
Practice Address - Country:US
Practice Address - Phone:860-423-1619
Practice Address - Fax:860-423-7640
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027147207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001271477Medicaid
180000289Medicare ID - Type Unspecified
CT001271477Medicaid
E43163Medicare UPIN