Provider Information for 1003349739
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COREY RYAN DWYER
Sex: Male
NPI: 1003349739
Last Updated: 2023-07-11
Certification Date: 2023-07-11
Certification Date: 2023-07-11
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1003349739 | ||||||||||||||
| Enumeration Date | 2017-04-10 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 263 FARMINGTON AVE FARMINGTON, CT 06032-1956 United States Phone: | Fax: | ||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06032-4038 United States Phone: 860-679-6600 | Fax:860-679-2109 | ||||||||||||||
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