Provider Information for 1871852079
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RYAN E ROBERTS
Sex: Female
NPI: 1871852079
Last Updated: 2015-04-16
Certification Date:
Certification Date:
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NPI | 1871852079 | ||||||||
Enumeration Date | 2012-05-08 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 40 MANSFIELD AVE WILLIMANTIC, CT 06226-2018 United States Phone: | Fax: | ||||||||
Primary Practice Address | 202 POMFRET ST PUTNAM, CT 06260-1833 United States Phone: 860-963-7917 | Fax:860-963-0015 | ||||||||
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