Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 9002 | CT |
NPI | 1083227920 |
---|---|
Provider Name | Richard Magee |
First Address | Oxford, CT 06478-1509 |
Second Address | Bridgeport, CT 06606-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2020 |
Last Update Date | 21/12/2020 |