Provider Demographics
NPI:1104871888
Name:BREIER, RICHARD ALAN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:BREIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 YORK ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-787-3588
Mailing Address - Fax:203-777-3767
Practice Address - Street 1:100 YORK ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:202-787-3588
Practice Address - Fax:203-777-3767
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010037627CT02OtherANTHEM INS
CT001376278Medicaid
2V6562OtherHEALTHNET
2147586OtherAETNA HEALTHPLAN
550797115OtherCIGNA HEALTHCARE
864421OtherCONNECTICARE
2147586OtherAETNA HEALTHPLAN
CT110007746Medicare ID - Type Unspecified