Provider Demographics
NPI:1528078995
Name:RIORDAN, ELIZABETH C (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:RIORDAN
Suffix:
Gender:F
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:PO BOX 1065
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-7065
Mailing Address - Country:US
Mailing Address - Phone:508-595-0531
Mailing Address - Fax:508-829-5367
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-238-2691
Practice Address - Fax:203-235-3128
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT045438208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01837214Medicaid
CT010045438CT02OtherANTHEM BCBS
NY427211Medicare ID - Type Unspecified
CT020001752Medicare PIN
NY01837214Medicaid