Provider Demographics
NPI:1306820956
Name:DUROCHER, RICHARD WILBROD (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILBROD
Last Name:DUROCHER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WASHINGTON AVE
Mailing Address - Street 2:STE 212
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2343
Mailing Address - Country:US
Mailing Address - Phone:203-239-1119
Mailing Address - Fax:203-234-1832
Practice Address - Street 1:20 WASHINGTON AVE
Practice Address - Street 2:STE 212
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2343
Practice Address - Country:US
Practice Address - Phone:203-239-1119
Practice Address - Fax:203-234-1832
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000709213ES0131X
MA2097213ES0131X
CT00709332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11066538OtherMULTIPLAN
CT80050OtherWELLCARE
CTCPD# 1392050OtherAETNA - COVENTRY-FIRST HEALTH
P1271789OtherOXFORD
CT0V3855OtherHEALTHNET
CT007090OtherCONNECTICARE
2704187OtherUNITED HEALTHCARE
CT008003227OtherMEDICAID GROUP AVRS
CT030000709CT01OtherBC BS
103244500OtherDEPT OF LABOR
CTC01740OtherMEDICARE GROUP PTAN
2110284OtherAETNA
60353065001OtherCIGNA
CT004191277Medicaid
CT480000766Medicare PIN
CT1296940001Medicare NSC
2704187OtherUNITED HEALTHCARE