Provider Demographics
NPI:1194924373
Name:RIDDLE, CARA D (DO)
Entity type:Individual
Prefix:DR
First Name:CARA
Middle Name:D
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 HEBRON AVE
Mailing Address - Street 2:HARTFORD MEDICAL GROUP
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3309
Mailing Address - Country:US
Mailing Address - Phone:860-696-2250
Mailing Address - Fax:860-696-2260
Practice Address - Street 1:676 HEBRON AVE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2410
Practice Address - Country:US
Practice Address - Phone:860-696-2250
Practice Address - Fax:860-696-2260
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1194924373Medicaid
1194924373OtherNPI
CT1194924373Medicaid