Provider Demographics
NPI:1306038674
Name:TABOADA, RICARDO (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:TABOADA
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 1:65 MEMORIAL RD
Mailing Address - Street 2:SUITE 435
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2434
Mailing Address - Country:US
Mailing Address - Phone:860-696-2840
Mailing Address - Fax:860-696-2845
Practice Address - Street 1:7101 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4947
Practice Address - Country:US
Practice Address - Phone:361-854-1910
Practice Address - Fax:361-884-1555
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT49915207LP2900X
TXU0664207LP2900X
PR26467207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology