Provider Demographics
NPI:1831174846
Name:RUARK, DARYLE A (MD)
Entity type:Individual
Prefix:
First Name:DARYLE
Middle Name:A
Last Name:RUARK
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 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2126
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-728-6740
Mailing Address - Fax:860-547-1554
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 2126
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-728-6740
Practice Address - Fax:860-547-1554
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217180207X00000X
CT54150207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2011859Medicaid
H89805Medicare UPIN
MA2011859Medicaid
MAA35740Medicare PIN
MANX2533Medicare PIN