Individual
MS. MARY ANN INDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.P.T.
Contact information
Practice address
93 WATERBURY RD, PROSPECT, CT 06712-1223
(203) 756-6569
(203) 758-0443
Mailing address
21 HOLLEY LN, PROSPECT, CT 06712-1484
(203) 756-6569
(203) 758-0443
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
002495
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080002495CT03
ANTHEM PROVIDER NUMBER
CT
Enumeration date
06/08/2009
Last updated
06/08/2009
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